Organization
WESTSIDE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK LAWRENCE KRAUS MD (PRESIDENT)
(203) 755-4577
Entity
Organization
Contact information
Practice address
714 CHASE PARKWAY, SUITE 6, WATERBURY, CT 06708-3939
(203) 755-4577
(203) 756-3628
Mailing address
714 CHASE PARKWAY, SUITE 6, WATERBURY, CT 06708-3939
(203) 755-4577
(203) 756-3628
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004085800
—
CT
01
—
50WESTSIDECT01
BCBS
—
Enumeration date
08/30/2006
Last updated
01/23/2012
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