Healthcare Provider Details

I. General information

NPI: 1871731927
Provider Name (Legal Business Name): COMPLETE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 STATE ST
NORTH HAVEN CT
06473-3019
US

IV. Provider business mailing address

451 STATE ST
NORTH HAVEN CT
06473-3019
US

V. Phone/Fax

Practice location:
  • Phone: 203-248-8888
  • Fax: 203-248-8889
Mailing address:
  • Phone: 203-248-8888
  • Fax: 203-248-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN A PARRETT
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 203-287-9071