Individual
DR. JOHN EDWIN RIVERA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1753 MERIDEN WATERBURY RD, MILLDALE, CT 06467-0770
(860) 621-5554
(860) 621-3833
Mailing address
1591 MERIDEN AVE, SOUTHINGTON, CT 06489-4208
(860) 621-6335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
026829
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026829
STATE MEDICAL LICENSE
CT
Enumeration date
04/26/2006
Last updated
07/08/2007
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