Provider Demographics
NPI:1356385868
Name:AHERN, JAMES K (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:AHERN
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 1:77 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4029
Mailing Address - Country:US
Mailing Address - Phone:203-431-6342
Mailing Address - Fax:203-438-4548
Practice Address - Street 1:77 DANBURY RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4029
Practice Address - Country:US
Practice Address - Phone:203-431-6342
Practice Address - Fax:203-438-4548
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB83886Medicare UPIN
CT080000379Medicare PIN