Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 025672 | CT |
NPI | 1003897851 |
---|---|
Provider Name | Robert M Bedard |
First Address | West Hartford, CT 06119 |
Second Address | West Hartford, CT 06119-1505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 04/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001256726 | (05) | CT |
00125672600 | BLUE CROSS MEDICAID (01) | |
004394508 | MEDICAID GROUP CAAC (01) | |
010025672CT01 | BLUE CROSS (01) | |
0127519002 | CIGNA (01) | |
051077 | CONNECTICARE (01) | |
226295 | PREFERRED ONE (01) | |
B38798 | (02) | |
OS2044 | HEALTHNET MEDICAID (01) | |
P2191290 | OXFORD (01) |