Provider Demographics
NPI:1609881432
Name:CONGDON, SANDRA THORNTON (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:THORNTON
Last Name:CONGDON
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:PO BOX 26899
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-6899
Mailing Address - Country:US
Mailing Address - Phone:800-276-6531
Mailing Address - Fax:
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-374-1515
Practice Address - Fax:203-374-4702
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029698207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001296989Medicaid
CT001296989Medicaid
CT050000873Medicare PIN