Provider Demographics
NPI:1952304263
Name:GARDEN, MITCHELL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:S
Last Name:GARDEN
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 1:622 BANTAM RD
Mailing Address - Street 2:
Mailing Address - City:BANTAM
Mailing Address - State:CT
Mailing Address - Zip Code:06750-1600
Mailing Address - Country:US
Mailing Address - Phone:860-361-6650
Mailing Address - Fax:860-361-6654
Practice Address - Street 1:622 BANTAM RD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-1600
Practice Address - Country:US
Practice Address - Phone:860-361-6650
Practice Address - Fax:860-361-6654
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044118174400000X, 207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY691155OtherMVP PROVIDER #
NYP958616OtherOXFORD PROVIDER #
NY5724688OtherAETNA PPO #
NY000000038402OtherGHI HMO #
NY01694311Medicaid
NY0599833OtherGHI PPO #
NY141796305OtherTAX IDENTIFICATION #
NY2071599OtherAETNA HMO #
NY000000038402OtherGHI HMO #
NY01694311Medicaid