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General NPI Number Information
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NPI Number | 1730146135
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Entity Type | Individual
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Provider Name | BRIAN T GIRARD D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 20 YORK ST YNHH TOMPKINS 2, RM 226
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City | NEW HAVEN
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State | CT
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Zip | 06510-3220
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Country | US
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Telephone | 203-688-9503
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Fax |
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Provider Business Mailing Address
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Address Line | 20 YORK ST YNHH TOMPKINS 2, RM 226
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City | NEW HAVEN
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State | CT
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Zip | 06510-3220
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Country | US
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Telephone | 203-688-9503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001255
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 001255
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 55012
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | LT-3705
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License Number State | NH
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