Provider Demographics
NPI:1558346338
Name:MONTEIRO, NIRMALA LOIS (MD)
Entity Type:Individual
Prefix:
First Name:NIRMALA
Middle Name:LOIS
Last Name:MONTEIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BEACH ROAD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824
Mailing Address - Country:US
Mailing Address - Phone:203-292-6500
Mailing Address - Fax:203-292-6500
Practice Address - Street 1:52 BEACH ROAD
Practice Address - Street 2:SUITE 107
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824
Practice Address - Country:US
Practice Address - Phone:203-292-6500
Practice Address - Fax:203-292-6502
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001268440Medicaid
B83727Medicare UPIN
CT110007082Medicare PIN
CT001268440Medicaid