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General NPI Number Information
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NPI Number | 1386630085
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Entity Type | Individual
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Provider Name | FERN ELLEN MAYER M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 260 LONG RIDGE RD STE 180
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City | STAMFORD
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State | CT
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Zip | 06902-1638
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Country | US
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Telephone | 203-969-0123
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Fax | 203-975-0760
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Provider Business Mailing Address
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Address Line | 260 LONG RIDGE RD STE D180
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City | STAMFORD
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State | CT
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Zip | 06902-1638
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Country | US
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Telephone | 203-969-0123
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Fax | 203-975-0760
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 030709
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License Number State | CT
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