Provider Demographics
NPI:1912192782
Name:GEORGE SHAFRANOV MD LLC
Entity Type:Organization
Organization Name:GEORGE SHAFRANOV MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFRANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-458-1221
Mailing Address - Street 1:705 BOSTON POST RD
Mailing Address - Street 2:C-3
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2732
Mailing Address - Country:US
Mailing Address - Phone:203-458-1221
Mailing Address - Fax:203-458-1960
Practice Address - Street 1:705 BOSTON POST RD
Practice Address - Street 2:C-3
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2732
Practice Address - Country:US
Practice Address - Phone:203-458-1221
Practice Address - Fax:203-458-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037866207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG95259Medicare UPIN