Basic Information
Provider Information
NPI: 1003806456
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CORDIDO
FirstName: RICARDO
MiddleName: F
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2200 WHITNEY AVE
Address2: SUITE 180
City: HAMDEN
State: CT
PostalCode: 065183691
CountryCode: US
TelephoneNumber: 2034072500
FaxNumber: 2034075812
Practice Location
Address1: 2200 WHITNEY AVE
Address2: SUITE 180
City: HAMDEN
State: CT
PostalCode: 065183691
CountryCode: US
TelephoneNumber: 2034072500
FaxNumber: 2034075812
Other Information
ProviderEnumerationDate: 10/26/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X027464CTY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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