Healthcare Provider Details

I. General information

NPI: 1962488981
Provider Name (Legal Business Name): BRIDGEPORT RADIOLOGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CORPORATE DR STE 325
SHELTON CT
06484-6295
US

IV. Provider business mailing address

1 CORPORATE DR STE 325
SHELTON CT
06484-6295
US

V. Phone/Fax

Practice location:
  • Phone: 203-696-3642
  • Fax: 203-331-9731
Mailing address:
  • Phone: 203-696-6125
  • Fax: 203-331-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: MR. IAN KAROL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 203-696-6125