Provider Demographics
NPI:1851387088
Name:FINKELSTEIN, FREDRIC O (MD)
Entity Type:Individual
Prefix:
First Name:FREDRIC
Middle Name:O
Last Name:FINKELSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-787-0117
Mailing Address - Fax:203-777-3559
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-787-0117
Practice Address - Fax:203-777-3559
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT16154207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001161546Medicaid
CT001161546Medicaid
CT390000148Medicare PIN