=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710103940
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMARY CARE PHYSICIANS OF FAIRFIELD, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 BEACH RD
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06824-6668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-259-7442
-----------------------------------------------------
Fax | 203-259-5108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 BEACH ROAD
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-259-7442
-----------------------------------------------------
Fax | 203-259-5108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NEIL E SMERLING
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 203-259-7442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 030941
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------