Healthcare Provider Details

I. General information

NPI: 1871767996
Provider Name (Legal Business Name): THOMAS A RAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 MAIN STREET
BRIDGEPORT CT
06606
US

IV. Provider business mailing address

3101 MAIN STREET
BRIDGEPORT CT
06606
US

V. Phone/Fax

Practice location:
  • Phone: 203-374-5892
  • Fax: 203-374-5822
Mailing address:
  • Phone: 203-374-5892
  • Fax: 203-374-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: THOMAS A RAGO
Title or Position: MD
Credential: MD
Phone: 203-374-5892