Provider Demographics
NPI:1053303693
Name:BRIDGERS, SAMUEL LEON (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LEON
Last Name:BRIDGERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2080 WHITNEY AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3600
Mailing Address - Country:US
Mailing Address - Phone:203-248-6200
Mailing Address - Fax:203-248-5479
Practice Address - Street 1:2080 WHITNEY AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3600
Practice Address - Country:US
Practice Address - Phone:203-248-6200
Practice Address - Fax:203-248-5479
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT236242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010023624CT05OtherANTHEM
CO682259OtherCTCARE
CTOV8177OtherHEALTHNET
CTNHS254OtherOXFORD HEALTHPLAN
CTNHS254OtherOXFORD HEALTHPLAN
CTD85308Medicare UPIN