Provider Demographics
NPI:1538104450
Name:WESTPORT FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:WESTPORT FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENADERET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-221-3030
Mailing Address - Street 1:129 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2438
Mailing Address - Country:US
Mailing Address - Phone:203-221-3030
Mailing Address - Fax:203-221-3131
Practice Address - Street 1:129 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2438
Practice Address - Country:US
Practice Address - Phone:203-221-3030
Practice Address - Fax:203-221-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty