Basic Information
| Provider Information | |||||||||
| NPI: | 1710103940 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRIMARY CARE PHYSICIANS OF FAIRFIELD, P.C. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 111 BEACH ROAD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032597442 | ||||||||
| FaxNumber: | 2032595108 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 BEACH RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068246668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032597442 | ||||||||
| FaxNumber: | 2032595108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SMERLING | ||||||||
| AuthorizedOfficialFirstName: | NEIL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2032597442 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 030941 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 707341 | 01 | CT | CONNECTICARE | OTHER | 2243369 | 01 | CT | UNITED | OTHER | 7570248 | 01 | CT | AETNA | OTHER | 010039435CT01 | 01 | CT | ANTHEM | OTHER | 10108 | 01 | CT | CIGNA | OTHER | 2V2747 | 01 | CT | HEALTH NET | OTHER | 0842207003 | 01 | CT | CIGNA | OTHER | 1339696 | 01 | CT | UNITED | OTHER | 530941 | 01 | CT | CONNECTICARE | OTHER | ZP187 | 01 | CT | OXFORD | OTHER | P2716247 | 01 | CT | OXFORD | OTHER | 003983 | 01 | CT | HEALTH NET | OTHER | 0100030941CT01 | 01 | CT | ANTHEM | OTHER | 4276527 | 01 | CT | AETNA | OTHER |