MEDICARE: MARYANN F RAMOS PA

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	363AM0700X	Medical Physician Assistant
2	363AM0700X	Medical Physician Assistant	002120	CT

General Provider Information

NPI Number	:	1841265840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN F RAMOS PA

Provider Business Mailing Address
First Line	:	35 HOMESTEAD RD
Second Line	:
City	:	GREENWICH
State	:	CT
Zip	:	06831-4222
Country	:	US
Telephone Number	:	203-531-5022
Fax Number	:	203-531-5022

Provider Business Practice Location Address
First Line	:	226 MILL HILL AVE
Second Line	:	BRIDGEPORT HOSPITAL INDUSTRIAL MEDICINE CENTER
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-0120
Country	:	US
Telephone Number	:	203-384-3613
Fax Number	:	203-384-4234

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	10/01/2008

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