Provider Demographics
NPI:1629003413
Name:NEGUS, PHILIP E (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:E
Last Name:NEGUS
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 1:1500 POST RD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5935
Mailing Address - Country:US
Mailing Address - Phone:203-276-4801
Mailing Address - Fax:203-276-4808
Practice Address - Street 1:1500 POST RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5935
Practice Address - Country:US
Practice Address - Phone:203-276-4801
Practice Address - Fax:203-276-4808
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB39492Medicare UPIN
CT110144792OtherRAILROAD MEDICARE
CT110000762Medicare ID - Type Unspecified
CTB39492Medicare UPIN