Provider Demographics
NPI:1447265228
Name:KURISH, DAVID REYNARD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:REYNARD
Last Name:KURISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:SHARON MEDICAL ARTS CTR
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069-0067
Mailing Address - Country:US
Mailing Address - Phone:860-364-0456
Mailing Address - Fax:860-364-5163
Practice Address - Street 1:29 HOSPITAL HILL RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2095
Practice Address - Country:US
Practice Address - Phone:860-364-0456
Practice Address - Fax:860-364-5163
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20638207R00000X
NY1650191207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00534932OtherMEDICAID
939034OtherMVP
CT001206382Medicaid
110229114OtherRAILROAD MEDICARE
010020638CT02OtherANTHEM BCBS
061008623OtherHMC PPO
0V0096OtherHEALTH NET
P562780OtherOXFORD
CT001206382Medicaid
0V0096OtherHEALTH NET