Individual
MR. RYAN WILLIAM MARINGOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6 FIELDSTONE CMNS STE D, TOLLAND, CT 06084-3419
(860) 875-2099
Mailing address
6 FIELDSTONE CMNS, SUITE D, TOLLAND, CT 06084-3419
(860) 875-2099
(860) 872-3021
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1969
CT
363AM0700X
Medical Physician Assistant
Primary
001969
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376739623
—
CT
Enumeration date
09/20/2007
Last updated
08/07/2018
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