Provider Demographics
NPI:1194937581
Name:PRIME HEALTHCARE OF SOUTHPORT,LLC
Entity type:Organization
Organization Name:PRIME HEALTHCARE OF SOUTHPORT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SARFRAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-254-9454
Mailing Address - Street 1:2000 POST RD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5730
Mailing Address - Country:US
Mailing Address - Phone:203-254-9454
Mailing Address - Fax:203-254-0152
Practice Address - Street 1:2000 POST RD
Practice Address - Street 2:SUITE #202
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5730
Practice Address - Country:US
Practice Address - Phone:203-254-9454
Practice Address - Fax:203-254-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG81681Medicare UPIN