MEDICARE: TABITHA FORTT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	037894	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427050426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA FORTT MD

Provider Business Mailing Address
First Line	:	23 HOYT ST
Second Line	:	SUITE #4
City	:	STAMFORD
State	:	CT
Zip	:	06905-5604
Country	:	US
Telephone Number	:	203-674-0774
Fax Number	:	203-674-0766

Provider Business Practice Location Address
First Line	:	23 HOYT ST
Second Line	:	SUITE #4
City	:	STAMFORD
State	:	CT
Zip	:	06905-5604
Country	:	US
Telephone Number	:	203-674-0774
Fax Number	:	203-674-0766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	02/24/2017

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