Provider Demographics
NPI:1053135467
Name:PLATT, BRYAN D (NRP, FP-C)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:D
Last Name:PLATT
Suffix:
Gender:M
Credentials:NRP, FP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LANZ LN
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-2312
Mailing Address - Country:US
Mailing Address - Phone:860-899-4178
Mailing Address - Fax:
Practice Address - Street 1:595 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-4008
Practice Address - Country:US
Practice Address - Phone:413-846-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001799146L00000X
MA0903857146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic