Provider Demographics
NPI:1760526396
Name:FAIRFIELD COUNTY PLASTIC SURGERY P.C.
Entity Type:Organization
Organization Name:FAIRFIELD COUNTY PLASTIC SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KIRWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-838-8844
Mailing Address - Street 1:605 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4000
Mailing Address - Country:US
Mailing Address - Phone:203-838-8844
Mailing Address - Fax:203-853-1862
Practice Address - Street 1:605 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-4000
Practice Address - Country:US
Practice Address - Phone:203-838-8844
Practice Address - Fax:203-853-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027865208200000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Not Answered2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
010027865CT02OtherANTHEM BC BS
CT0192OtherHEALTHNET
ZS317OtherOXFORD
2780650OtherCONNECTICARE