Basic Information
| Provider Information | |||||||||
| NPI: | 1568543288 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENSPAN | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 KINGS HWY E | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068254867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036106300 | ||||||||
| FaxNumber: | 2036106347 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 KINGS HWY E | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068254867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036106300 | ||||||||
| FaxNumber: | 2036106347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 05/31/2013 | ||||||||
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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 | 207RP1001X | 043568 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 043568 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RS0012X | 043568 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207R00000X | 043568 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001435686 | 05 | CT | MEDICAID |