Healthcare Provider Details

I. General information

NPI: 1821387580
Provider Name (Legal Business Name): SIMON FORBES DESJARDINS SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SPRING ST
NEW BEDFORD MA
02740-5951
US

IV. Provider business mailing address

106 SPRING ST
NEW BEDFORD MA
02740-5951
US

V. Phone/Fax

Practice location:
  • Phone: 508-997-6091
  • Fax:
Mailing address:
  • Phone: 508-997-6091
  • Fax: 508-999-7795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number281954
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: