Provider Demographics
NPI:1073570842
Name:LITWIN, KENNETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:LITWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:27 GLEN RD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482
Mailing Address - Country:US
Mailing Address - Phone:203-304-9502
Mailing Address - Fax:203-304-9503
Practice Address - Street 1:27 GLEN RD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482
Practice Address - Country:US
Practice Address - Phone:203-304-9502
Practice Address - Fax:203-304-9503
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT037343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001373430Medicaid
G88823Medicare UPIN
CT110008363Medicare PIN