Healthcare Provider Details

I. General information

NPI: 1144415399
Provider Name (Legal Business Name): FAIRFIELD COUNTY COLOPROCTOLOGY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 EAST AVE SUITE 3B
NORWALK CT
06851-5721
US

IV. Provider business mailing address

148 EAST AVE SUITE 3B
NORWALK CT
06851-5721
US

V. Phone/Fax

Practice location:
  • Phone: 203-853-1705
  • Fax: 203-854-9161
Mailing address:
  • Phone: 203-853-1705
  • Fax: 203-854-9161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number017818
License Number StateCT

VIII. Authorized Official

Name: DR. JAMES F. GUTHRIE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-853-1705