Provider Demographics
NPI:1376566042
Name:BRITVAN, J. ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:J. ALLEN
Middle Name:
Last Name:BRITVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PERRYRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830
Mailing Address - Country:US
Mailing Address - Phone:203-863-3000
Mailing Address - Fax:203-863-4783
Practice Address - Street 1:5 PERRYRIDGE RD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4608
Practice Address - Country:US
Practice Address - Phone:203-863-3637
Practice Address - Fax:203-863-3281
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026785207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110001727OtherMEDICARE PROVIDER #
CT110001727OtherMEDICARE PROVIDER #
CT110001727Medicare ID - Type Unspecified