Provider Demographics
NPI:1932168739
Name:NORDBERG, KAREN P (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:P
Last Name:NORDBERG
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 1:38B GROVE ST
Mailing Address - Street 2:RIDGEFIELD PEDIATRIC ASSOCIATES
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4667
Mailing Address - Country:US
Mailing Address - Phone:203-438-9557
Mailing Address - Fax:203-438-7857
Practice Address - Street 1:38B GROVE ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4667
Practice Address - Country:US
Practice Address - Phone:203-438-9557
Practice Address - Fax:203-438-7857
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045766208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H65646Medicare UPIN