Individual
SHANE THOMAS RIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
250 FLAT ROCK PL, 2ND FL, WESTBROOK, CT 06498-1565
(860) 358-3640
(860) 358-8656
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-4820
(860) 358-8661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
045427
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008024237
—
CT
Enumeration date
07/20/2007
Last updated
04/11/2017
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