Provider Demographics
NPI:1598761918
Name:BAYER, MARC J (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:J
Last Name:BAYER
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 1:10 WYNDEMERE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3959
Mailing Address - Country:US
Mailing Address - Phone:860-676-1444
Mailing Address - Fax:
Practice Address - Street 1:10 WYNDEMERE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3959
Practice Address - Country:US
Practice Address - Phone:860-676-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032539207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1598761918Medicaid
CT1598761918Medicaid
CTD38461Medicare UPIN