Basic Information
| Provider Information | |||||||||
| NPI: | 1447280052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AWAD | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 BLACK ROCK TPKE | ||||||||
| Address2: | ORTHOPAEDIC SPECIALTY GROUP | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068255508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033372600 | ||||||||
| FaxNumber: | 2033372666 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 BLACK ROCK TPKE | ||||||||
| Address2: | ORTHOPAEDIC SPECIALTY GROUP | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068255508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033372600 | ||||||||
| FaxNumber: | 2033372666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 043636 | CT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3970447 | 01 | CT | AETNA | OTHER | 669G1 | 01 | CT | EMPIRE BC/BS | OTHER | TIN | 01 | NEHDA | OTHER | P3630094 | 01 | CT | OXFORD HEALTH PLANS | OTHER | 2V2648 | 01 | CT | HEALTH NET | OTHER | TIN | 01 | CORVEL | OTHER | TIN | 01 | GREAT WEST | OTHER | TIN | 01 | NORTHEAST HEALTH DIRECT | OTHER | TIN | 01 | POMCO | OTHER | 010043636CT01 | 01 | CT | ANTHEM BC/BS | OTHER | 043636 | 01 | CT | CONNECTICARE | OTHER | 4434430 | 01 | CT | CIGNA | OTHER | TIN | 01 | FIRST HEALTH/ CCN | OTHER | 001436361 | 05 | CT | MEDICAID | 200001097 | 01 | CT | MULTIPLAN | OTHER | TIN | 01 | PIONEER | OTHER | TIN | 01 | UNITED HEALTHCARE | OTHER |