Healthcare Provider Details

I. General information

NPI: 1144228941
Provider Name (Legal Business Name): OBSTETRICS-GYNECOLOGY & INFERTILITY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S MAIN ST
CHESHIRE CT
06410-3153
US

IV. Provider business mailing address

675 S MAIN ST
CHESHIRE CT
06410-3153
US

V. Phone/Fax

Practice location:
  • Phone: 203-272-1811
  • Fax: 203-250-2162
Mailing address:
  • Phone: 203-272-1811
  • Fax: 203-250-2162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: DR. KIM C FLETCHER
Title or Position: PRESIDENT/MANAGING PARTNER
Credential: MD
Phone: 203-272-1811