Provider Demographics
NPI:1750351995
Name:THORNTON, SCOTT CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHRISTOPHER
Last Name:THORNTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 POST RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6016
Mailing Address - Country:US
Mailing Address - Phone:203-255-7088
Mailing Address - Fax:203-255-7926
Practice Address - Street 1:1305 POST RD
Practice Address - Street 2:SUITE 215
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6016
Practice Address - Country:US
Practice Address - Phone:203-255-7088
Practice Address - Fax:203-255-7926
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030110208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001301100Medicaid
CT001301100Medicaid
CTF26851Medicare UPIN