Provider Demographics
NPI:1871586057
Name:DUERR, SEAN (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:DUERR
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 1:2900 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4946
Mailing Address - Country:US
Mailing Address - Phone:203-378-4500
Mailing Address - Fax:203-378-8220
Practice Address - Street 1:2900 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4946
Practice Address - Country:US
Practice Address - Phone:203-378-4500
Practice Address - Fax:203-378-8220
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT16863208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020001749OtherMEDICARE PTAN
020001749OtherMEDICARE PTAN
CTD32600Medicare UPIN