Provider Demographics
NPI:1760665426
Name:WILTON OB/GYN, LLC
Entity Type:Organization
Organization Name:WILTON OB/GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FUCIGNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-834-2237
Mailing Address - Street 1:396 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2024
Mailing Address - Country:US
Mailing Address - Phone:203-834-2237
Mailing Address - Fax:
Practice Address - Street 1:396 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2024
Practice Address - Country:US
Practice Address - Phone:203-834-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG21989Medicare UPIN