Individual
MICHAEL DERRICK MINARDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
538 LITCHFIELD ST STE 102, TORRINGTON, CT 06790-6669
(860) 496-8990
Mailing address
503 HIGHCROFT PL, WEATOGUE, CT 06089-7916
(970) 948-7267
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4206
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4206
PHYSICIAN ASSISTANT LICENSE
CT
Enumeration date
08/27/2018
Last updated
08/27/2018
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