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General NPI Number Information
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NPI Number | 1902230030
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Entity Type | Organization
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Legal Business Name | NORTH END MEDICAL GROUP LLC
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 3690 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-3610
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Country | US
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Telephone | 203-579-9000
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Fax | 203-374-6132
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Provider Business Mailing Address
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Address Line | 3690 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-3610
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Country | US
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Telephone | 203-579-9000
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Fax | 203-374-6132
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Authorized Official
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Title or Position | MANAGER
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Name | WAYNE S LEVIN
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Credential | M.D.
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Telephone | 203-579-9000
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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 | 050053
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 047525
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 020625
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License Number State | CT
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