Healthcare Provider Details

I. General information

NPI: 1346391109
Provider Name (Legal Business Name): PULMONARY & INTERNAL MEDICINE OF FAIRFIELD COUNTY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4699 MAIN ST SUITE 209
BRIDGEPORT CT
06606
US

IV. Provider business mailing address

4699 MAIN ST SUITE 209
BRIDGEPORT CT
06606-1830
US

V. Phone/Fax

Practice location:
  • Phone: 203-374-2747
  • Fax: 203-372-0204
Mailing address:
  • Phone: 203-374-2747
  • Fax: 203-372-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LANA WEISMAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 203-374-2747