| Bridgeport Health Department | |
|
99 Middle St Bridgeport CT 06604-4410 | |
| (203) 576-7448 | |
| Not Available |
| Full Name | Bridgeport Health Department |
|---|---|
| Speciality | Clinic/Center |
| Location | 99 Middle St, Bridgeport, Connecticut |
| Authorized Official Name and Position | Manisha Gupta (INTERNAL MEDICINE) |
| Authorized Official Contact | 2035767448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeport Health Department 99 Middle St Bridgeport CT 06604-4410 Ph: (203) 576-7448 | Bridgeport Health Department 99 Middle St Bridgeport CT 06604-4410 Ph: (203) 576-7448 |
| NPI Number | 1730436783 |
|---|---|
| Provider Enumeration Date | 08/09/2012 |
| Last Update Date | 09/01/2023 |
| Medicare PECOS PAC ID | 2365842309 |
|---|---|
| Medicare Enrollment ID | O20210614002428 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730436783 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0905X | Clinic/center - Public Health, State Or Local | 0033 (Connecticut) | Primary |
| Provider Name | Hadrian Marlowe Holder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083093181 PECOS PAC ID: 0042597239 Enrollment ID: I20191202001557 |
| Provider Name | Deirdre Gruber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609317080 PECOS PAC ID: 8628478666 Enrollment ID: I20210614002633 |
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