Provider Demographics
NPI:1518014539
Name:ABIDOR, GERARD (DO)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:
Last Name:ABIDOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ALBION ST
Mailing Address - Street 2:SOUTHWEST COMMUNITY HEALTH CENTER, INC
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-2602
Mailing Address - Country:US
Mailing Address - Phone:203-330-6000
Mailing Address - Fax:203-330-6008
Practice Address - Street 1:968 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1116
Practice Address - Country:US
Practice Address - Phone:203-330-6000
Practice Address - Fax:203-382-9425
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001388562Medicaid
CT110008283Medicare ID - Type Unspecified
CTD400143670Medicare PIN
CTH38902Medicare UPIN