Provider Demographics
NPI:1144354002
Name:MATERNAL FETAL CARE, P.C.
Entity type:Organization
Organization Name:MATERNAL FETAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:VISCARELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-978-5775
Mailing Address - Street 1:1275 SUMMER ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5359
Mailing Address - Country:US
Mailing Address - Phone:203-978-5775
Mailing Address - Fax:203-978-5777
Practice Address - Street 1:1275 SUMMER ST
Practice Address - Street 2:SUITE 306
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5359
Practice Address - Country:US
Practice Address - Phone:203-978-5775
Practice Address - Fax:203-978-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028952207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE84435Medicare UPIN