Provider Demographics
NPI:1144228941
Name:OBSTETRICS-GYNECOLOGY & INFERTILITY GROUP PC
Entity Type:Organization
Organization Name:OBSTETRICS-GYNECOLOGY & INFERTILITY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-272-1811
Mailing Address - Street 1:675 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3153
Mailing Address - Country:US
Mailing Address - Phone:203-272-1811
Mailing Address - Fax:203-250-2162
Practice Address - Street 1:675 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3153
Practice Address - Country:US
Practice Address - Phone:203-272-1811
Practice Address - Fax:203-250-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207V00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCM0873OtherMEDICARE RAILROAD
CT004045811Medicaid
CT004262846Medicaid