MEDICARE: EASTSHORE PEDIATRICS

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	207R00000X	Internal Medicine Physician
2	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16917	OTHER	CT	CDS

General Provider Information

NPI Number	:	1508876103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTSHORE PEDIATRICS

Provider Business Mailing Address
First Line	:	1556 NEW HAVEN AVE
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-8220
Country	:	US
Telephone Number	:	203-878-5941
Fax Number	:

Provider Business Practice Location Address
First Line	:	1556 NEW HAVEN AVE
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-8220
Country	:	US
Telephone Number	:	203-878-5941
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAN PETER FUGAL
Credential	:	MD
Telephone Number	:	203-878-5941

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	09/11/2025

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Directions to “EASTSHORE PEDIATRICS ” Practice Location

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