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General NPI Number Information
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NPI Number | 1366822199
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Entity Type | Organization
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Legal Business Name | HOUSE CALLS AND VIRTUAL VISITS, LLC
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Dates
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Enumeration Date | 06/06/2015
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Last Update Date | 06/06/2015
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Provider Practice Location Address
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Address Line | 36 SANFORD ST
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City | FAIRFIELD
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State | CT
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Zip | 06824-5917
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Country | US
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Telephone | 203-259-1911
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Fax |
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Provider Business Mailing Address
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Address Line | 36 SANFORD ST
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City | FAIRFIELD
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State | CT
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Zip | 06824-5917
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Country | US
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Telephone | 203-259-1911
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LEE FOREST
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Credential | D.O.
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Telephone | 203-259-1911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 039202
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License Number State | CT
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