Basic Information
| Provider Information | |||||||||
| NPI: | 1831200187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARTH | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | BITTMANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 146 DANBURY RD | ||||||||
| Address2: | |||||||||
| City: | NEW MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067763427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603504000 | ||||||||
| FaxNumber: | 8603555581 | ||||||||
| Practice Location | |||||||||
| Address1: | 1302 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067061748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035979044 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | 029085 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207QH0002X | 029085 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207Q00000X | 029085 | CT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1290858 | 05 | CT | MEDICAID |