Healthcare Provider Details

I. General information

NPI: 1790706570
Provider Name (Legal Business Name): ROBERT ALAN ZIKARAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2456 PARK AVE
BRIDGEPORT CT
06604-1403
US

IV. Provider business mailing address

2456 PARK AVE
BRIDGEPORT CT
06604-1403
US

V. Phone/Fax

Practice location:
  • Phone: 203-332-7117
  • Fax:
Mailing address:
  • Phone: 203-332-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0238989
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: