Provider Demographics
NPI:1316370661
Name:MAUD WARD, M.D. LLC
Entity Type:Organization
Organization Name:MAUD WARD, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUD
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-272-0333
Mailing Address - Street 1:366 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3115
Mailing Address - Country:US
Mailing Address - Phone:203-272-0333
Mailing Address - Fax:203-272-0332
Practice Address - Street 1:366 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3115
Practice Address - Country:US
Practice Address - Phone:203-272-0333
Practice Address - Fax:203-272-0332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAUD WARD, M.D., LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001221689Medicaid
CT110236727OtherRAILROAD MEDICARE
CT001221689Medicaid
CT110008615Medicare PIN