Provider Demographics
NPI:1508872219
Name:BARTFELD, EPHRAIM P (MD)
Entity Type:Individual
Prefix:DR
First Name:EPHRAIM
Middle Name:P
Last Name:BARTFELD
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 1:380 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2260
Mailing Address - Country:US
Mailing Address - Phone:860-274-8891
Mailing Address - Fax:860-274-8895
Practice Address - Street 1:380 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2260
Practice Address - Country:US
Practice Address - Phone:860-274-8891
Practice Address - Fax:860-274-8895
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0359032080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001359034Medicaid
CTG50804Medicare UPIN