Organization
OLD OAK PRIMARY CARE, P.C.
Active
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
Update your record
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