Provider Demographics
NPI:1407952997
Name:SURGICAL SPECIALISTS OF GREENWICH
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF GREENWICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCWHORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-863-4300
Mailing Address - Street 1:77 LAFAYETTE PL STE 301
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5426
Mailing Address - Country:US
Mailing Address - Phone:203-863-4300
Mailing Address - Fax:203-863-4310
Practice Address - Street 1:77 LAFAYETTE PL
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5426
Practice Address - Country:US
Practice Address - Phone:203-863-4300
Practice Address - Fax:203-863-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019443208600000X
CT033066208600000X
CT043286208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH63126Medicare UPIN
CTF60854Medicare UPIN
CTB38525Medicare UPIN