Healthcare Provider Details

I. General information

NPI: 1902118185
Provider Name (Legal Business Name): AMIT BARDIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2010
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

300 GEORGE ST FL 6
NEW HAVEN CT
06511-6624
US

V. Phone/Fax

Practice location:
  • Phone: 617-834-6918
  • Fax:
Mailing address:
  • Phone: 203-785-6610
  • Fax: 203-785-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number054665
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number054665
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number244403
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: