Provider Demographics
NPI:1457561862
Name:BARD, STELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:STELLA
Middle Name:
Last Name:BARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 LAMPLIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5609
Mailing Address - Country:US
Mailing Address - Phone:718-906-6327
Mailing Address - Fax:412-324-7399
Practice Address - Street 1:1250 OCEAN PKWY STE LN
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5155
Practice Address - Country:US
Practice Address - Phone:718-906-6327
Practice Address - Fax:718-303-0984
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5838207RR0500X
NY244064207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02982598Medicaid