Healthcare Provider Details

I. General information

NPI: 1982680948
Provider Name (Legal Business Name): KATHLEEN ANNE FEARN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SARGENT DR STE 6
NEW HAVEN CT
06511-6110
US

IV. Provider business mailing address

150 SARGENT DR STE 6
NEW HAVEN CT
06511-6110
US

V. Phone/Fax

Practice location:
  • Phone: 203-781-4321
  • Fax: 203-781-4329
Mailing address:
  • Phone: 203-781-4321
  • Fax: 203-781-4329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number022971
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number022971
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: