Provider Demographics
NPI:1770518151
Name:BEZAHLER, RONALD C (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:BEZAHLER
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 1:70 MERIDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3272
Mailing Address - Country:US
Mailing Address - Phone:860-621-6757
Mailing Address - Fax:860-621-6790
Practice Address - Street 1:70 MERIDEN AVE
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3272
Practice Address - Country:US
Practice Address - Phone:860-621-6757
Practice Address - Fax:860-621-6790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028133207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001281336Medicaid
028133OtherCONNECTICARE
010028133CT01OtherBCBS
01028133OtherCIGNA
HAS008OtherOXFORD
OR0617OtherHEALTHNET
4218003OtherAETNA
180005457OtherRAILROAD MEDICARE
B84194Medicare UPIN
010028133CT01OtherBCBS