Provider Demographics
NPI:1720590706
Name:FERNANDO BARAHONA MD PC
Entity Type:Organization
Organization Name:FERNANDO BARAHONA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAHONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-424-7995
Mailing Address - Street 1:1435 BEDFORD ST STE 1N
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5225
Mailing Address - Country:US
Mailing Address - Phone:203-424-7995
Mailing Address - Fax:
Practice Address - Street 1:1435 BEDFORD ST STE 1N
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5225
Practice Address - Country:US
Practice Address - Phone:203-424-7995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty