Individual
BRENDAN COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
595 MAIN ST, MANCHESTER, CT 06040-5160
(860) 559-5178
Mailing address
568 FOSTER ST, SOUTH WINDSOR, CT 06074-2935
(860) 559-5178
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
03-912955
CT
Other
Enumeration date
09/18/2014
Last updated
09/18/2014
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