Provider Demographics
NPI:1407984222
Name:SOUTHBURY MEDICAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:SOUTHBURY MEDICAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FITZHUGH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PANNILL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:203-264-6503
Mailing Address - Street 1:22 OLD WATERBURY ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488
Mailing Address - Country:US
Mailing Address - Phone:203-264-6503
Mailing Address - Fax:203-262-1430
Practice Address - Street 1:22 OLD WATERBURY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3848
Practice Address - Country:US
Practice Address - Phone:203-264-6503
Practice Address - Fax:203-262-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty