Provider Demographics
NPI:1891728853
Name:NEGBENEBOR, DARLENE S (MD)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:S
Last Name:NEGBENEBOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MORGAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5466
Mailing Address - Country:US
Mailing Address - Phone:203-998-7400
Mailing Address - Fax:203-358-4755
Practice Address - Street 1:90 MORGAN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5466
Practice Address - Country:US
Practice Address - Phone:203-998-7400
Practice Address - Fax:203-358-4755
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043139174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001431395Medicaid
CTI36545Medicare UPIN
CT001431395Medicaid