Basic Information
| Provider Information | |||||||||
| NPI: | 1407297203 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORWALK MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 STEVENS ST | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068503852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038454800 | ||||||||
| FaxNumber: | 2038454897 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 STEVENS ST | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068503852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038454800 | ||||||||
| FaxNumber: | 2038454897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2013 | ||||||||
| LastUpdateDate: | 07/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | ZAHRAH | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | HEMATOLOGY - ONCOLOGY | ||||||||
| AuthorizedOfficialTelephone: | 2038454894 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | 038431 | CT | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.