Provider Demographics
NPI:1568999480
Name:BARDEN, MARY MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MICHELE
Last Name:BARDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 GEORGE ST APT 7C
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6646
Mailing Address - Country:US
Mailing Address - Phone:401-316-9509
Mailing Address - Fax:
Practice Address - Street 1:35 PARK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1110
Practice Address - Country:US
Practice Address - Phone:203-200-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT674782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology