Individual
RICHARD PAUL DIBALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1022 STORRS RD, STORRS MANSFIELD, CT 06268-2639
(860) 429-9321
(860) 429-4775
Mailing address
16 JACOBS HILL RD, MANSFIELD CENTER, CT 06250-1650
(860) 456-2863
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
022511
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001225119
—
CT
01
—
080001969
MEDICARE ID
CT
Enumeration date
08/31/2006
Last updated
05/29/2008
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