Individual
CAROL J FIFTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
495 GOLD STAR HWY, SUITE 120, GROTON, CT 06340-6228
(860) 449-8882
(860) 449-9195
Mailing address
495 GOLD STAR HWY, SUITE 120, GROTON, CT 06340-6228
(860) 449-8882
(860) 449-9195
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
032252
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001322528
—
CT
01
—
010032252CT02
BLUE CROSS BLUE SHIELD
—
01
—
030238
HEALTH NET
—
01
—
2213688-003
CIGNA
—
01
—
5761082
AETNA
—
01
—
721293
CIGNA
—
01
—
NLP056
OXFORD
—
Enumeration date
11/13/2006
Last updated
07/08/2007
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