Provider Demographics
NPI:1871667055
Name:ONCOLOGY ASSOCIATES OF BRIDGEPORT PC
Entity Type:Organization
Organization Name:ONCOLOGY ASSOCIATES OF BRIDGEPORT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-502-8400
Mailing Address - Street 1:5520 PARK AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3463
Mailing Address - Country:US
Mailing Address - Phone:203-502-8400
Mailing Address - Fax:203-502-8409
Practice Address - Street 1:5520 PARK AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3463
Practice Address - Country:US
Practice Address - Phone:203-502-8400
Practice Address - Fax:203-502-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0725530001Medicare NSC