Healthcare Provider Details

I. General information

NPI: 1366856817
Provider Name (Legal Business Name): CHRISTOFER JOHN FORT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 VILLAGE GREEN DR
LITCHFIELD CT
06759-3433
US

IV. Provider business mailing address

130 CT RTE 37
NEW FAIRFIELD CT
06812
US

V. Phone/Fax

Practice location:
  • Phone: 860-567-0130
  • Fax: 860-567-0125
Mailing address:
  • Phone: 203-746-6000
  • Fax: 203-739-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number56411
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number56411
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: