Provider Demographics
NPI:1992779862
Name:I'ANSON, VALERIE A (MD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:I'ANSON
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 1:2660 MAIN ST STE 216
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5301
Mailing Address - Country:US
Mailing Address - Phone:203-576-5346
Mailing Address - Fax:203-581-6509
Practice Address - Street 1:1055 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6019
Practice Address - Country:US
Practice Address - Phone:203-259-3440
Practice Address - Fax:203-254-3889
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT24281207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D95244Medicare UPIN
930001061Medicare ID - Type Unspecified