=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588899405
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC DENIS GIRARD M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2009
-----------------------------------------------------
Last Update Date | 09/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 FARMINGTON AVE #352
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-1909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-676-1110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | UCONN MEDICAL GROUP 263 FARMINGTON AVENUE
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06030-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-679-8080
-----------------------------------------------------
Fax | 860-679-1430
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208C00000X
-----------------------------------------------------
Taxonomy Name | Colon & Rectal Surgery Physician
-----------------------------------------------------
License Number | 056499
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------