Provider Demographics
NPI:1457960767
Name:MCBRIDE, REGINA (HEALTH CARE PROVIDER)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:HEALTH CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3924
Mailing Address - Country:US
Mailing Address - Phone:203-360-8626
Mailing Address - Fax:203-333-1669
Practice Address - Street 1:940 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3924
Practice Address - Country:US
Practice Address - Phone:203-360-8626
Practice Address - Fax:203-333-1669
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13462543747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty