Healthcare Provider Details

I. General information

NPI: 1790170181
Provider Name (Legal Business Name): OLEG SOSTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL AVE
DANBURY CT
06810
US

IV. Provider business mailing address

615 AVALON LAKE RD
DANBURY CT
06810-7362
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-6959
  • Fax: 203-749-9031
Mailing address:
  • Phone: 503-840-8607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60166
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number60166
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: