Provider Demographics
NPI:1700927720
Name:PRIMARY CARE OF SHELTON LLC
Entity Type:Organization
Organization Name:PRIMARY CARE OF SHELTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASGARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-225-0506
Mailing Address - Street 1:555 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4749
Mailing Address - Country:US
Mailing Address - Phone:203-225-0506
Mailing Address - Fax:
Practice Address - Street 1:555 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4749
Practice Address - Country:US
Practice Address - Phone:203-225-0506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty