Basic Information
| Provider Information | |||||||||
| NPI: | 1831174846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUARK | ||||||||
| FirstName: | DARYLE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 ASYLUM AVE | ||||||||
| Address2: | SUITE 2126 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607286740 | ||||||||
| FaxNumber: | 8605471554 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 ASYLUM AVE | ||||||||
| Address2: | SUITE 2126 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607286740 | ||||||||
| FaxNumber: | 8605471554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 217180 | MA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 54150 | CT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2011859 | 05 | MA | MEDICAID |