Provider Demographics
NPI:1538296231
Name:FAIRFIELDPRIMARYHEALTHCARE,LLC
Entity Type:Organization
Organization Name:FAIRFIELDPRIMARYHEALTHCARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERESHTEH
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:AHMADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-255-2340
Mailing Address - Street 1:1261 POST RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6072
Mailing Address - Country:US
Mailing Address - Phone:203-255-2340
Mailing Address - Fax:203-255-0619
Practice Address - Street 1:1261 POST RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6072
Practice Address - Country:US
Practice Address - Phone:203-255-2340
Practice Address - Fax:203-255-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033474261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF88321Medicare UPIN