Healthcare Provider Details

I. General information

NPI: 1548359078
Provider Name (Legal Business Name): CHARLES R ESPOSITO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 ROUTE 12
GALES FERRY CT
06335-1800
US

IV. Provider business mailing address

1527 ROUTE 12 PO BOX 608
GALES FERRY CT
06335-1800
US

V. Phone/Fax

Practice location:
  • Phone: 860-464-7248
  • Fax: 860-464-0125
Mailing address:
  • Phone: 860-464-7248
  • Fax: 860-464-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number022809
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: