Provider Demographics
NPI:1366571424
Name:EBRIGHT, MICHAEL IRWIN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:IRWIN
Last Name:EBRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 HOSPITAL PLAZA
Mailing Address - Street 2:SUITE 505
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-276-4404
Mailing Address - Fax:203-276-4405
Practice Address - Street 1:29 HOSPITAL PLAZA
Practice Address - Street 2:SUITE 505
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-4404
Practice Address - Fax:203-276-4405
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT052469208G00000X, 208G00000X
MA232590208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110075871AMedicaid
MA000296301Medicare PIN