Individual
MONIQUE MISRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
64 BLACK ROCK AVE, BRIDGEPORT, CT 06605-1200
(203) 579-5000
(203) 579-5113
Mailing address
471 BARNUM AVE, BRIDGEPORT, CT 06608-2409
(203) 333-6864
(203) 332-0376
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
045313
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045313
STATE LICENSE 045313
CT
Enumeration date
07/20/2007
Last updated
01/08/2010
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