Healthcare Provider Details

I. General information

NPI: 1174549257
Provider Name (Legal Business Name): BRIDGEPORT ANESTHESIA ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GRANT ST
BRIDGEPORT CT
06610-2805
US

IV. Provider business mailing address

7365 MAIN ST SUITE 310
STRATFORD CT
06614-1300
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH STONE
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 203-384-3072