Modern Era Pediatric Practice in Bridgeport - Adolescent Medicine
Modern Era Pediatric Practice - NPI 1194817460
Modern Era Pediatric Practice is a Adolescent Medicine in Bridgeport, Connecticut. Modern Era Pediatric Practice practices all healthcare services and medical treatments related to Adolescent Medicine. The NPI Number for Modern Era Pediatric Practice is 1194817460. The last update date is 2012-11-09.
Modern Era Pediatric Practice's current location address is 3715 Main St, Bridgeport, Connecticut. You can contact this provider via phone number 2033714800 and fax number 2033714900. The mailing address for Modern Era Pediatric Practice is 3715 Main St, Bridgeport, Connecticut. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Modern Era Pediatric Practice |
|---|---|
| Address | 3715 Main St, Bridgeport, Connecticut |
| Phone Number | 2033714800 |
| Fax Number | 2033714900 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | MEDICAL DI |
|---|---|
| Authorized Official Name | Anyoha Chibuike Anselm |
| Credentials | MD |
| Telephone Number | 2033714800 |
NPI Number Detail
| NPI Number | 1194817460 |
|---|---|
| Provider Enumeration Date | 2006-09-28 |
| Last Updated Date | 2012-11-09 |
Provider Mailing Address Detail
| Address | 3715 Main St |
|---|---|
| City | Bridgeport |
| State | Connecticut (CT) |
| Post Code | 66063618 |
| Phone Number | 2033714800 |
| Fax Number | 2033714900 |
Provider's Primary Taxonomy Detail
| Speciality | Adolescent Medicine |
|---|---|
| Taxonomy | 2080A0000X |
|
Definition: A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1352799 | CT | -- |
Post Comment/ Review Below
What is the Modern Era Pediatric Practice's unique identification number?
The Modern Era Pediatric Practice has been assigned the NPI (National Provider Identifier) Number 1194817460 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Could you please share the complete physical location address where Modern Era Pediatric Practice's facilities are situated?
The facilities of Modern Era Pediatric Practice are physically located at the following address: 3715 Main St, Bridgeport, CT, 66063618.
What is Modern Era Pediatric Practice's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Modern Era Pediatric Practice is Adolescent Medicine, and the taxonomy code that categorizes this field of expertise is 2080A0000X.
On what date did the Modern Era Pediatric Practice receive its 1194817460 assignment from the Centers for Medicare & Medicaid Services?
The Modern Era Pediatric Practice was assigned its 1194817460 by the Centers for Medicare & Medicaid Services on 2006-09-28.
As of what date were the details related to Modern Era Pediatric Practice most recently updated or revised?
The information pertaining to Modern Era Pediatric Practice, including its address, specialty, and other relevant details, was last updated or revised on 2012-11-09.