Provider Demographics
NPI:1639255318
Name:BAMFORD, NIGEL S (MD)
Entity Type:Individual
Prefix:
First Name:NIGEL
Middle Name:S
Last Name:BAMFORD
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 1:15 YORK ST
Mailing Address - Street 2:LMP3088
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3221
Mailing Address - Country:US
Mailing Address - Phone:203-737-2315
Mailing Address - Fax:203-737-2236
Practice Address - Street 1:15 YORK ST
Practice Address - Street 2:LMP3088
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3221
Practice Address - Country:US
Practice Address - Phone:203-737-2315
Practice Address - Fax:203-737-2236
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000413012084N0400X
CT545142084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8322125Medicaid
292090OtherINTERNAL ID-MOTOR VEHICLE ID
292090OtherINTERNAL ID-MOTOR VEHICLE ID
WA8322125Medicaid