| Bridgeport Family Medicine Llc | |
|
754 Clinton Ave Bridgeport CT 06604 | |
| (203) 243-6018 | |
| Not Available |
| Full Name | Bridgeport Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 754 Clinton Ave, Bridgeport, Connecticut |
| Authorized Official Name and Position | Awais Malik (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2032436018 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeport Family Medicine Llc 112 Sunnyridge Ave Fairfield CT 06824-4620 Ph: (203) 243-6018 | Bridgeport Family Medicine Llc 754 Clinton Ave Bridgeport CT 06604 Ph: (203) 243-6018 |
| NPI Number | 1548642283 |
|---|---|
| Provider Enumeration Date | 06/18/2015 |
| Last Update Date | 06/18/2015 |
| Medicare PECOS PAC ID | 3870803844 |
|---|---|
| Medicare Enrollment ID | O20151103000889 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548642283 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 049851 (Connecticut) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | 049851 (Connecticut) | Secondary |
| Provider Name | Awais Malik |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508025594 PECOS PAC ID: 1355505249 Enrollment ID: I20120605000314 |
| Provider Name | Sherif A Saleh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699087999 PECOS PAC ID: 4284900135 Enrollment ID: I20171023000111 |
| Provider Name | Shanza Ihsan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669865044 PECOS PAC ID: 3375807621 Enrollment ID: I20180514001647 |
| Provider Name | Shandel Reith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942844949 PECOS PAC ID: 6901231158 Enrollment ID: I20200115002554 |
| Provider Name | Susmita Adhikari |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356901201 PECOS PAC ID: 4385061118 Enrollment ID: I20200825002875 |
| Provider Name | Tabia Thompson-lamothe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932716628 PECOS PAC ID: 2860809142 Enrollment ID: I20210402000891 |
| Provider Name | Kelly M Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780267153 PECOS PAC ID: 0941609994 Enrollment ID: I20210525002239 |
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