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General NPI Number Information
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NPI Number | 1235597741
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Entity Type | Organization
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Legal Business Name | TABITHA B. FORTT, M.D., LLC
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 37 GLENBROOK RD SUITE #3
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City | STAMFORD
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State | CT
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Zip | 06902-2913
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Country | US
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Telephone | 203-674-0774
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Fax | 203-674-0766
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Provider Business Mailing Address
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Address Line | 37 GLENBROOK RD SUITE #3
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City | STAMFORD
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State | CT
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Zip | 06902-2913
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Country | US
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Telephone | 203-674-0774
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Fax | 203-674-0766
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | DR. TABITHA B FORTT
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Credential | M.D.
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Telephone | 203-674-0774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 037894
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License Number State | CT
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