Provider Demographics
NPI:1639280928
Name:WOMEN'S MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:WOMEN'S MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:MASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-374-4433
Mailing Address - Street 1:4749 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1805
Mailing Address - Country:US
Mailing Address - Phone:203-374-4433
Mailing Address - Fax:203-374-5033
Practice Address - Street 1:4749 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1805
Practice Address - Country:US
Practice Address - Phone:203-374-4433
Practice Address - Fax:203-374-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20077174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001200773Medicaid
CT160000380Medicare PIN
CTB38164Medicare UPIN
CT001200773Medicaid