Provider Demographics
NPI:1093783326
Name:LANDRY, ARTHUR BERNARD JR (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:BERNARD
Last Name:LANDRY
Suffix:JR
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 1:711 COTTAGE GROVE RD
Mailing Address - Street 2:COTTAGE GROVE CARDIOLOGY
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3060
Mailing Address - Country:US
Mailing Address - Phone:860-242-8756
Mailing Address - Fax:860-769-5009
Practice Address - Street 1:711 COTTAGE GROVE RD
Practice Address - Street 2:COTTAGE GROVE CARDIOLOGY
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3060
Practice Address - Country:US
Practice Address - Phone:860-242-8756
Practice Address - Fax:860-769-5009
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008880207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001088806Medicaid
CTP00065347OtherRAILROAD MEDICARE
060001521Medicare ID - Type Unspecified
B39611Medicare UPIN