Provider Demographics
NPI:1558676973
Name:SAMUEL L BRIDGERS MD LLC
Entity Type:Organization
Organization Name:SAMUEL L BRIDGERS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRIDGERS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:203-248-6200
Mailing Address - Street 1:2080 WHITNEY AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3600
Mailing Address - Country:US
Mailing Address - Phone:203-248-6200
Mailing Address - Fax:203-248-5479
Practice Address - Street 1:2080 WHITNEY AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3600
Practice Address - Country:US
Practice Address - Phone:203-248-6200
Practice Address - Fax:203-248-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT236242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT130000542Medicare PIN