=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316370661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAUD WARD, M.D. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2013
-----------------------------------------------------
Last Update Date | 08/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 366 S MAIN ST
-----------------------------------------------------
City | CHESHIRE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06410-3115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-272-0333
-----------------------------------------------------
Fax | 203-272-0332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 366 SOUTH MAIN ST
-----------------------------------------------------
City | CHESHIRE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06410-3115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-272-0333
-----------------------------------------------------
Fax | 203-272-0332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SINGLE MEMBER
-----------------------------------------------------
Name | DR. MAUD WARD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 203-272-0333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 022168
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------