Provider Demographics
NPI:1033440367
Name:BRUCE R. BARON, M.D., PC
Entity Type:Organization
Organization Name:BRUCE R. BARON, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:203-329-8651
Mailing Address - Street 1:583 HIGH RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-2602
Mailing Address - Country:US
Mailing Address - Phone:203-329-8651
Mailing Address - Fax:203-968-2635
Practice Address - Street 1:583 HIGH RIDGE RD.
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-2602
Practice Address - Country:US
Practice Address - Phone:203-329-8651
Practice Address - Fax:203-968-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1137686Medicaid
CT1137686Medicaid