Modern Era Pediatric Practice

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

MODERN ERA PEDIATRIC PRACTICE

Practice address

3715 Main St
Suite 403
Bridgeport, CT 06606-3618

Phone

(203) 371-4800

Fax

(203) 371-4900

NPI assigned

Sep 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Anselm Chibuike Anyoha, MDNPI 1598788770

Title

Medical Director

Phone

(203) 371-4800

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anselm Chibuike Anyoha, MD

  • Pediatrics Physician
  • Bridgeport, CT
  • NPI 1598788770

  Adolescent Medicine

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352419200000",
    "number": "1194817460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3715 MAIN ST",
            "address_2": "SUITE 403",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066063618",
            "telephone_number": "203-371-4800",
            "fax_number": "203-371-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3715 MAIN ST",
            "address_2": "SUITE 403",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066063618",
            "telephone_number": "203-371-4800",
            "fax_number": "203-371-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN ERA PEDIATRIC PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2012-11-09",
        "status": "A",
        "authorized_official_last_name": "ANYOHA",
        "authorized_official_first_name": "ANSELM",
        "authorized_official_middle_name": "CHIBUIKE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "203-371-4800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001352799",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanessa Mix
• Charles Haviland Mize, M.D.
• Mobile CV Imaging, LLC
• Mobile Orthotic & Prosthetic Services
• Modern Care Medical Supplies LLC
• Ingrid E Mody, PA-C
• Oak Gar Moe
• Andrea Teresa Moenkemoeller
• Balaphanidhar Mogga, MD
• Shannon Naresh Mohabir, DO

• Pediatric Adolescent Medicine Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Pediatric Adolescent Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.