Healthcare Provider Details

I. General information

NPI: 1598761918
Provider Name (Legal Business Name): MARC J BAYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WYNDEMERE
AVON CT
06001-3959
US

IV. Provider business mailing address

10 WYNDEMERE
AVON CT
06001-3959
US

V. Phone/Fax

Practice location:
  • Phone: 860-676-1444
  • Fax:
Mailing address:
  • Phone: 860-676-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number032539
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: