Individual
PAUL L FORTGANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 LONG WHARF DR, SUITE 302, NEW HAVEN, CT 06511-5991
(203) 865-1185
(203) 776-7741
Mailing address
1 LONG WHARF DR, SUITE 302, NEW HAVEN, CT 06511-5991
(203) 865-1185
(203) 776-7741
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
028622
CT
207YP0228X
Pediatric Otolaryngology Physician
028622
CT
207YX0602X
Otolaryngic Allergy Physician
028622
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001286228
—
CT
01
—
040001967
RAILROAD MEDICARE PIN
CT
Enumeration date
07/24/2006
Last updated
07/02/2009
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