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NPI Code Detail

MEDICARE: COASTAL OBSTETRICS AND GYNECOLOGY PC

MEDICARE: COASTAL OBSTETRICS AND GYNECOLOGY PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist028989CT
2207V00000XObstetrics & Gynecology PhysicianCT

General Provider Information

NPI Number : 1679842611
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL OBSTETRICS AND GYNECOLOGY PC
Provider Business Mailing Address
First Line : 999 SUMMER ST STE 401
Second Line :
City : STAMFORD
State : CT
Zip : 06905-5513
Country : US
Telephone Number : 203-353-9099
Fax Number : 203-353-9699
Provider Business Practice Location Address
First Line : 999 SUMMER ST STE 401
Second Line :
City : STAMFORD
State : CT
Zip : 06905-5513
Country : US
Telephone Number : 203-353-9099
Fax Number : 203-353-9699
Authorized Official
Title or Position : PRESIDENT
Name : ROBERT J GENNARO
Credential : MD
Telephone Number : 203-353-9099
Provider Enumeration Date : 12/20/2011
Last Update Date : 07/21/2022

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Directions to “COASTAL OBSTETRICS AND GYNECOLOGY PC ” Practice Location

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