Provider Demographics
NPI:1093905812
Name:WESTPORT CARDIOLOGY,LLC
Entity Type:Organization
Organization Name:WESTPORT CARDIOLOGY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KARPENOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-226-1760
Mailing Address - Street 1:32 IMPERIAL AVE
Mailing Address - Street 2:FL. 2
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4328
Mailing Address - Country:US
Mailing Address - Phone:203-226-1760
Mailing Address - Fax:203-221-8291
Practice Address - Street 1:WESTPORT CARDIOLOGY, LLC
Practice Address - Street 2:32 IMPERIAL AVE.
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-226-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001685Medicare PIN
CT060001694Medicare PIN