Active NPI
Michael Fortgang, M.D.
- Specialist
- Danbury, CT
National Provider Identifier
1255349700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 027366
- Practice address
- 36 Tamarack Ave
PBM 118
Danbury, CT 06811-4822 - Phone
- (203) 739-7532
- Fax
- (203) 743-2610
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 027366 | CT | Primary |
Addresses
Primary practice location
36 Tamarack Ave
PBM 118
Danbury, CT 06811-4822
Mailing address
230 Saugatuck Ave
Westport, CT 06880-6401
Phone (203) 739-7532
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 027366 | CT | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diagnostic Imaging of Milford, PC | Past | Accepting new patients | |
| Diagnostic Imaging of Milford, PC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Milford, CT
- NPI 1154354850
-
- Durable Medical Equipment & Medical Supplies
- Milford, CT
- NPI 1821615196
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255349700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 SAUGATUCK AVE",
"city": "WESTPORT",
"state": "CT",
"postal_code": "068806401",
"telephone_number": "203-739-7532",
"fax_number": "203-743-2610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 TAMARACK AVE",
"address_2": "PBM 118",
"city": "DANBURY",
"state": "CT",
"postal_code": "068114822",
"telephone_number": "203-739-7532",
"fax_number": "203-743-2610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTGANG",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CT",
"license": "027366",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Danbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.