Healthcare Provider Details

I. General information

NPI: 1235348145
Provider Name (Legal Business Name): CARDIOVASCULAR PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN ST
BRIDGEPORT CT
06606-4201
US

IV. Provider business mailing address

PO BOX 166
SHELTON CT
06484-0166
US

V. Phone/Fax

Practice location:
  • Phone: 203-576-5708
  • Fax: 203-367-8392
Mailing address:
  • Phone: 203-225-0247
  • Fax: 203-225-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number029101
License Number StateCT

VIII. Authorized Official

Name: DR. DANIEL M. ROSE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-576-5708