| Fairfield County Medical Group, Pc | |
|
15 Corporate Dr Suite 2-1 Trumbull CT 06611-1351 | |
| (203) 459-5100 | |
| (203) 452-2424 |
| Full Name | Fairfield County Medical Group, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 15 Corporate Dr, Trumbull, Connecticut |
| Authorized Official Name and Position | Frank Spano (PRESIDENT) |
| Authorized Official Contact | 2034595100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairfield County Medical Group, Pc 15 Corporate Dr Suite 2-1 Trumbull CT 06611-1351 Ph: (203) 459-5100 | Fairfield County Medical Group, Pc 15 Corporate Dr Suite 2-1 Trumbull CT 06611-1351 Ph: (203) 459-5100 |
| NPI Number | 1639195415 |
|---|---|
| Provider Enumeration Date | 07/14/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 0446141329 |
|---|---|
| Medicare Enrollment ID | O20040322000572 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639195415 | NPI | - | NPPES |
| C12675 | Other | CT | RAILROAD MEDICARE PTAN |
| 50FFLDCMGCT01 | Other | CT | ANTHEM BLUE CROSS BLUE SH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 028987 (Connecticut) | Primary |
| Provider Name | Michael A Cassetta |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1811916505 PECOS PAC ID: 4587657960 Enrollment ID: I20040405000033 |
| Provider Name | Frank Spano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194744417 PECOS PAC ID: 9032000427 Enrollment ID: I20100920000109 |
| Provider Name | Glenn M Rich |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1922027259 PECOS PAC ID: 2163615709 Enrollment ID: I20101015000170 |
| Provider Name | Steven Fisher |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679592984 PECOS PAC ID: 2062600174 Enrollment ID: I20101215001183 |
| Provider Name | Stephanie F Merck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235158932 PECOS PAC ID: 9133318033 Enrollment ID: I20110107000428 |
| Provider Name | Kimberly Ann Pearson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750860862 PECOS PAC ID: 0446504526 Enrollment ID: I20181107002663 |
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