Provider Demographics
NPI:1912197781
Name:BRISTOL SURGICAL GROUP, P.C.
Entity Type:Organization
Organization Name:BRISTOL SURGICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAGDASARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-583-2003
Mailing Address - Street 1:25 NEWELL RD
Mailing Address - Street 2:SUITE D-21
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5100
Mailing Address - Country:US
Mailing Address - Phone:860-583-2003
Mailing Address - Fax:860-583-1639
Practice Address - Street 1:25 NEWELL RD
Practice Address - Street 2:SUITE D-21
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5100
Practice Address - Country:US
Practice Address - Phone:860-583-2003
Practice Address - Fax:860-583-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT707866174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty