Provider Demographics
NPI:1598834152
Name:BIRD, ELIZABETH MADELINE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MADELINE
Last Name:BIRD
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 1:2 DEEP HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06412-1112
Mailing Address - Country:US
Mailing Address - Phone:860-532-0525
Mailing Address - Fax:860-483-5314
Practice Address - Street 1:20 WATER ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:CT
Practice Address - Zip Code:06412
Practice Address - Country:US
Practice Address - Phone:860-532-0525
Practice Address - Fax:860-483-5314
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53136208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1598834152OtherNPI
CT008080251Medicaid