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General NPI Number Information
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NPI Number | 1770881153
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE OF DR.KARKANITSA, LLC
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 6580 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06614-1605
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Country | US
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Telephone | 203-435-2719
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Fax |
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Provider Business Mailing Address
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Address Line | 6580 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06614-1605
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Country | US
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Telephone | 203-435-2719
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Fax |
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Authorized Official
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Title or Position | HEAD
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Name | DR. LEONID V KARKANITSA
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Credential | M.D., PH.D.
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Telephone | 203-285-0791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 043534
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License Number State | CT
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