Provider Demographics
NPI:1770089237
Name:RIVERA, MILDRED DILORIS (MD)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:DILORIS
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6600
Mailing Address - Country:US
Mailing Address - Phone:860-496-6646
Mailing Address - Fax:860-496-6665
Practice Address - Street 1:540 LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6600
Practice Address - Country:US
Practice Address - Phone:860-496-6666
Practice Address - Fax:860-496-6783
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT068139208M00000X
390200000X
CT68139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program