Provider Demographics
NPI:1568541761
Name:OREN, BRAD EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:EVAN
Last Name:OREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EAST AVE STE 335
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5014
Mailing Address - Country:US
Mailing Address - Phone:203-853-2020
Mailing Address - Fax:203-852-9553
Practice Address - Street 1:111 EAST AVE STE 335
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-853-2020
Practice Address - Fax:203-852-9553
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT055187207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255206000Medicaid
FL44431ZOtherMEDICARE PTAN
FLGS635AOtherMEDICARE PTAN
FL65-0868500OtherTAX ID
FL255206000Medicaid