Provider Demographics
NPI:1356766448
Name:CHARD, FREDERICK JAMES IV (IDC)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:JAMES
Last Name:CHARD
Suffix:IV
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SOUTH RD APT 4B
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4641
Mailing Address - Country:US
Mailing Address - Phone:860-356-6153
Mailing Address - Fax:
Practice Address - Street 1:55 SOUTH RD APT 4B
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4641
Practice Address - Country:US
Practice Address - Phone:860-356-6153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman