Provider Demographics
NPI:1336486141
Name:JOAO NASCIMENTO MD LLC
Entity Type:Organization
Organization Name:JOAO NASCIMENTO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAO
Authorized Official - Middle Name:
Authorized Official - Last Name:NASCIMENTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-371-0009
Mailing Address - Street 1:3203 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4225
Mailing Address - Country:US
Mailing Address - Phone:203-371-0009
Mailing Address - Fax:203-371-0091
Practice Address - Street 1:3203 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4225
Practice Address - Country:US
Practice Address - Phone:203-371-0009
Practice Address - Fax:203-371-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT129415174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty