Healthcare Provider Details

I. General information

NPI: 1659859080
Provider Name (Legal Business Name): COASTAL CONNECTICUT MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2018
Last Update Date: 07/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 MAIN ST BLDG SUITE1F
STRATFORD CT
06614-4946
US

IV. Provider business mailing address

1 E PUTNAM AVE
GREENWICH CT
06830-5429
US

V. Phone/Fax

Practice location:
  • Phone: 203-658-6051
  • Fax: 203-658-6051
Mailing address:
  • Phone: 203-658-6051
  • Fax: 203-658-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN MURPHY
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 203-658-6051