Provider Demographics
NPI:1881640332
Name:SKLUTH, MYRA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:L
Last Name:SKLUTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 WASHINGTON BLVD
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3722
Mailing Address - Country:US
Mailing Address - Phone:203-348-7500
Mailing Address - Fax:203-964-9029
Practice Address - Street 1:750 WASHINGTON BLVD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3722
Practice Address - Country:US
Practice Address - Phone:203-348-7500
Practice Address - Fax:203-964-9029
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT029609207R00000X, 207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110007730Medicare PIN
CTD98347Medicare UPIN