Provider Demographics
NPI:1154519502
Name:MILFORD OB GYN PHYSICIANS P C
Entity type:Organization
Organization Name:MILFORD OB GYN PHYSICIANS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-878-5913
Mailing Address - Street 1:309 SEASIDE AVE
Mailing Address - Street 2:SUITE 203-204
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4625
Mailing Address - Country:US
Mailing Address - Phone:203-878-5913
Mailing Address - Fax:203-882-8997
Practice Address - Street 1:309 SEASIDE AVE
Practice Address - Street 2:SUITE 203-204
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4625
Practice Address - Country:US
Practice Address - Phone:203-878-5913
Practice Address - Fax:203-882-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03051Medicare PIN