Healthcare Provider Details

I. General information

NPI: 1790746337
Provider Name (Legal Business Name): INTERNAL MEDICINE OF EAST HAVEN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 N MAIN ST STE 5
BRANFORD CT
06405-3044
US

IV. Provider business mailing address

144 N MAIN ST STE 5
BRANFORD CT
06405-3044
US

V. Phone/Fax

Practice location:
  • Phone: 203-468-9775
  • Fax:
Mailing address:
  • Phone: 203-468-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number024717
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number024588
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number030998
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK SHERARD KASPER
Title or Position: PRESIDENT
Credential: MD
Phone: 203-468-9775