Provider Demographics
NPI:1477531218
Name:BARD, ADAM JASON (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JASON
Last Name:BARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2150 BLACK ROCK TURNPIKE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825
Mailing Address - Country:US
Mailing Address - Phone:203-384-2227
Mailing Address - Fax:203-384-2022
Practice Address - Street 1:2150 BLACK ROCK TURNPIKE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825
Practice Address - Country:US
Practice Address - Phone:203-384-2227
Practice Address - Fax:203-384-2022
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT043863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H85947Medicare UPIN