Provider Demographics
NPI:1184670176
Name:EAST SHORE DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:EAST SHORE DISTRICT HEALTH DEPARTMENT
Other - Org Name:EAST SHORE HEALTH DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL ADVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-481-4233
Mailing Address - Street 1:688 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2971
Mailing Address - Country:US
Mailing Address - Phone:203-481-4233
Mailing Address - Fax:203-483-6894
Practice Address - Street 1:688 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2971
Practice Address - Country:US
Practice Address - Phone:203-481-4233
Practice Address - Fax:203-483-6894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028111251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare