Provider Demographics
NPI:1093383689
Name:CONNECTICUT PLASTIC SURGERY ASSOCIATES LLC
Entity Type:Organization
Organization Name:CONNECTICUT PLASTIC SURGERY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-557-4356
Mailing Address - Street 1:1391 POST RD E FL 2
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5508
Mailing Address - Country:US
Mailing Address - Phone:203-557-4356
Mailing Address - Fax:
Practice Address - Street 1:1391 POST RD E FL 2
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5508
Practice Address - Country:US
Practice Address - Phone:203-557-4356
Practice Address - Fax:203-557-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty