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Organization
MODERN ERA PEDIATRIC PRACTICE
Active
Organization
MODERN ERA PEDIATRIC PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANSELM CHIBUIKE ANYOHA MD (MEDICAL DIRECTOR)
(203) 371-4800
Entity
Organization
Contact information
Practice address
3715 MAIN ST, SUITE 403, BRIDGEPORT, CT 06606-3618
(203) 371-4800
(203) 371-4900
Mailing address
3715 MAIN ST, SUITE 403, BRIDGEPORT, CT 06606-3618
(203) 371-4800
(203) 371-4900
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
09/28/2006
Last updated
11/09/2012
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