Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD26914 | OR |
NPI | 1003864497 |
---|---|
Provider Name | Mark Justin Fletcher |
First Address | Norwalk, CT 06851-1080 |
Second Address | Norwalk, CT 06851-1080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 05/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278332 | (05) | OR |
I59599 | (02) |