Individual
ANDREA DOUYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
179 ROSELAND AVE, WATERBURY, CT 06710
(203) 574-4747
(203) 574-2251
Mailing address
179 ROSELAND AVE, WATERBURY, CT 06710-1411
(203) 574-4747
(203) 574-2251
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000597
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008036775
—
CT
01
—
1186042
USA
CT
01
—
PENDING
RAILROAD MEDICARE
CT
Enumeration date
07/11/2006
Last updated
07/22/2014
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