IRA D MICKENBERG
Physician/surgeon


Address: 312 Three Mile Hill Rd, Middlebury, CT 06762-1711

IRA D MICKENBERG (Credential# 541158) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is October 1, 2011. The license expiration date date is September 30, 2012. The license status is INACTIVE.

Business Overview

IRA D MICKENBERG is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.014557. The credential type is physician/surgeon. The effective date is October 1, 2011. The expiration date is September 30, 2012. The business address is 312 Three Mile Hill Rd, Middlebury, CT 06762-1711. The current status is inactive.

Basic Information

Licensee Name IRA D MICKENBERG
Credential ID 541158
Credential Number 1.014557
Credential Type Physician/Surgeon
Business Address 312 Three Mile Hill Rd
Middlebury
CT 06762-1711
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 1970-08-06
Effective Date 2011-10-01
Expiration Date 2012-09-30
Refresh Date 2013-01-07

Other licenses

ID Credential Code Credential Type Issue Term Status
146884 CSP.0000424 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 2008-03-01 - 2009-02-28 INACTIVE

Office Location

Street Address 312 Three Mile Hill Rd
City MIDDLEBURY
State CT
Zip Code 06762-1711

Licenses in the same location

Licensee Name Office Address Credential Effective / Expiration
Patricia C Fahey Ms 312 Three Mile Hill Rd, Middlebury, CT 06762-1711 Registered Nurse 2019-01-01 ~ 2019-12-31

Licenses in the same zip code

Licensee Name Office Address Credential Effective / Expiration
Joanne L Kaday 364 Three Mile Hill Rd, Middlebury, CT 06762-1711 Radiographer 2020-09-01 ~ 2021-08-31
Donna M Devino 330 Three Mile Hill Rd, Middlebury, CT 06762-1711 Radiographer 2019-10-01 ~ 2020-09-30
Gary J Welton 286 Three Mile Hill Rd, Middlebury, CT 06762-1711 Wholesaler Salesman 2015-02-02 ~ 2017-01-31

Licenses in the same zip code

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Patricia E Rosa · Lambo 76 East Farm Rd, Middlebury, CT 06762 Registered Nurse 2020-08-01 ~ 2021-07-31
Kathy Ann Calo · Bellino 116 Carriage Drive, Middlebury, CT 06762 Hairdresser/cosmetician 2020-06-01 ~ 2022-05-31
Laurie V Massetti 60 Yale Avenue, Middlebury, CT 06762 Registered Nurse 2020-07-01 ~ 2021-06-30
Timex Corp Park Rd Ext, Middlebury, CT 06762 Operator of Weighing & Measuring Devices 2020-08-01 ~ 2021-07-31
Margaret E Mowrey 57 Marney Drive, Middlebury, CT 06762 Licensed Clinical Social Worker 2020-08-01 ~ 2021-07-31
Giuseppe Tripodi 687 Straits Tpk, Middlebury, CT 06762 Physician/surgeon 2020-08-01 ~ 2021-07-31
Elise L Callahan 77 Christian Rd, Middlebury, CT 06762 Registered Nurse 2020-08-01 ~ 2021-07-31
Michelle King 91 Kissewaug Rd, Middlebury, CT 06762 Registered Nurse 2020-07-01 ~ 2021-06-30
Michael F Simms IIi 80 Burr Hall Road, Middlebury, CT 06762 Physician/surgeon 2020-07-01 ~ 2021-06-30
Kelly M Barbaris 62 Yale Avenue, Middlebury, CT 06762 Physical Therapist 2020-07-01 ~ 2021-06-30
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Competitor

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City MIDDLEBURY
Zip Code 06762
License Type Physician/Surgeon
License Type + County Physician/Surgeon + MIDDLEBURY

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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