Healthcare Provider Details

I. General information

NPI: 1902541196
Provider Name (Legal Business Name): JAN TADEUSZ MARKIEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date: 01/30/2023
Reactivation Date: 02/06/2023

III. Provider practice location address

267 GRANT STREET BRIDGEPORT HOSPITAL, DEPARTMENT OF MEDICINE
BRIDGEPORT CT
06610
US

IV. Provider business mailing address

60 STRAWBERRY HILL AVE UNIT 803
STAMFORD CT
06902-8500
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3000
  • Fax: 203-384-4294
Mailing address:
  • Phone: 332-260-5097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: