Provider Demographics
NPI:1356670731
Name:FAIRFIELD COUNTY PRIMARY CARE, PC
Entity Type:Organization
Organization Name:FAIRFIELD COUNTY PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-372-1900
Mailing Address - Street 1:345 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1547
Mailing Address - Country:US
Mailing Address - Phone:203-849-7777
Mailing Address - Fax:203-846-4477
Practice Address - Street 1:345 MAIN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1547
Practice Address - Country:US
Practice Address - Phone:203-849-7777
Practice Address - Fax:203-846-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty