Organization
FAIRFIELD COUNTY MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK SPANO M.D. (PRESIDENT)
(203) 459-5100
Entity
Organization
Contact information
Practice address
15 CORPORATE DR, SUITE 2-1, TRUMBULL, CT 06611-1351
(203) 459-5100
(203) 452-2424
Mailing address
15 CORPORATE DR, SUITE 2-1, TRUMBULL, CT 06611-1351
(203) 459-5100
(203) 452-2424
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
028987
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50FFLDCMGCT01
ANTHEM BLUE CROSS BLUE SH
CT
01
—
C12675
RAILROAD MEDICARE PTAN
CT
Enumeration date
07/14/2006
Last updated
04/20/2008
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