Provider Demographics
NPI:1063438463
Name:FUTORYAN, TANYA S (MD)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:S
Last Name:FUTORYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 POST RD E
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4435
Mailing Address - Country:US
Mailing Address - Phone:203-226-3600
Mailing Address - Fax:203-226-2555
Practice Address - Street 1:489 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4435
Practice Address - Country:US
Practice Address - Phone:203-226-3600
Practice Address - Fax:203-226-2555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035123207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG25671Medicare UPIN
CT070000354Medicare PIN