Organization
OLD OAK PRIMARY CARE, P.C.
Active
Other names
Old Oak Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOFER JOHN FORT MD (PRESIDENT)
(203) 533-9436
Entity
Organization
Contact information
Practice address
250 MAIN ST S UNIT G, SOUTHBURY, CT 06488-2263
(203) 533-9436
(989) 419-3050
Mailing address
250 MAIN ST S UNIT G, SOUTHBURY, CT 06488-2263
(203) 533-9436
(989) 419-3050
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
056411
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008073500
—
CT
Enumeration date
08/02/2018
Last updated
12/21/2018
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