Basic Information
| Provider Information | |||||||||
| NPI: | 1871667055 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONCOLOGY ASSOCIATES OF BRIDGEPORT PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5520 PARK AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066113463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035028400 | ||||||||
| FaxNumber: | 2035028409 | ||||||||
| Practice Location | |||||||||
| Address1: | 5520 PARK AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066113463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035028400 | ||||||||
| FaxNumber: | 2035028409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 07/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | FOLMAN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2035028400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.