| Tabitha B. Fortt, M.d., Llc | |
|
37 Glenbrook Rd Suite #3 Stamford CT 06902-2913 | |
| (203) 674-0774 | |
| (203) 674-0766 |
| Full Name | Tabitha B. Fortt, M.d., Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 37 Glenbrook Rd, Stamford, Connecticut |
| Authorized Official Name and Position | Tabitha B Fortt (MEMBER/MANAGER) |
| Authorized Official Contact | 2036740774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tabitha B. Fortt, M.d., Llc 37 Glenbrook Rd Suite #3 Stamford CT 06902-2913 Ph: (203) 674-0774 | Tabitha B. Fortt, M.d., Llc 37 Glenbrook Rd Suite #3 Stamford CT 06902-2913 Ph: (203) 674-0774 |
| NPI Number | 1235597741 |
|---|---|
| Provider Enumeration Date | 01/29/2016 |
| Last Update Date | 02/02/2016 |
| Medicare PECOS PAC ID | 1850681362 |
|---|---|
| Medicare Enrollment ID | O20160610001545 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235597741 | NPI | - | NPPES |
| 008036735 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 037894 (Connecticut) | Primary |
| Provider Name | Tabitha B Fortt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427050426 PECOS PAC ID: 5890794408 Enrollment ID: I20061208000388 |
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