Provider Demographics
NPI:1710984372
Name:FLETCHER, KIM C (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:C
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:C
Other - Last Name:BRYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:675 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3153
Mailing Address - Country:US
Mailing Address - Phone:203-250-2125
Mailing Address - Fax:203-250-2162
Practice Address - Street 1:675 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3153
Practice Address - Country:US
Practice Address - Phone:203-272-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028006207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT160007538OtherMEDICARE RAILROAD
CT001280065Medicaid
CT1600000618OtherMEDICARE
NHP096OtherOXFORD HEALTHPLAN
CT010028006CT01OtherANTHEM BLUE CROSS & BLUE SHEILD OF CT
028006OtherCONNECTCARE
0813379002OtherCIGNA
0Q0164OtherHEALTHNET
0740884OtherUNITED HEALTHCARE
CT2017507OtherAETNA
0813379002OtherCIGNA