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General NPI Number Information
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NPI Number | 1790746337
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE OF EAST HAVEN PC
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 339 HEMINGWAY AVE
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City | EAST HAVEN
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State | CT
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Zip | 06512-2318
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Country | US
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Telephone | 203-468-9775
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Fax |
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Provider Business Mailing Address
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Address Line | 339 HEMINGWAY AVE
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City | EAST HAVEN
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State | CT
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Zip | 06512-2318
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Country | US
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Telephone | 203-468-9775
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK SHERARD KASPER
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Credential | MD
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Telephone | 203-468-9775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 024717
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 024588
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 030998
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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