Basic Information
Provider Information
NPI: 1831118736
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUFFY
FirstName: JAMES
MiddleName: D.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 PERKINS FARM DRIVE
Address2: SUITE 102
City: MYSTIC
State: CT
PostalCode: 06355
CountryCode: US
TelephoneNumber: 5107521000
FaxNumber:  
Practice Location
Address1: 100 PERKINS FARM DRIVE
Address2: SUITE 102
City: MYSTIC
State: CT
PostalCode: 06355
CountryCode: US
TelephoneNumber: 8608706385
FaxNumber: 8602450000
Other Information
ProviderEnumerationDate: 07/19/2006
LastUpdateDate: 07/19/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/19/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XC56124CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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