Provider Demographics
NPI:1003838509
Name:WIBLE-KANT, JOANNE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:LYNN
Last Name:WIBLE-KANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4749 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1805
Mailing Address - Country:US
Mailing Address - Phone:203-365-4922
Mailing Address - Fax:203-374-2377
Practice Address - Street 1:4749 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1805
Practice Address - Country:US
Practice Address - Phone:203-365-4922
Practice Address - Fax:203-374-2377
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028567207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1285675Medicaid
CT160000985Medicare PIN
CTB83350Medicare UPIN