Organization
TABITHA B. FORTT, M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TABITHA B FORTT M.D. (MEMBER/MANAGER)
(203) 674-0774
Entity
Organization
Contact information
Practice address
37 GLENBROOK RD, SUITE #3, STAMFORD, CT 06902-2913
(203) 674-0774
(203) 674-0766
Mailing address
37 GLENBROOK RD, SUITE #3, STAMFORD, CT 06902-2913
(203) 674-0774
(203) 674-0766
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
037894
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008036735
—
CT
Enumeration date
01/29/2016
Last updated
02/02/2016
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