Provider Demographics
NPI:1487637203
Name:BIZZARRO, MATTHEW JOHN (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:BIZZARRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GEORGE ST
Mailing Address - Street 2:6TH FLOOR PO BOX 9805
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06536-0805
Mailing Address - Country:US
Mailing Address - Phone:203-785-7998
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YALE-NEW HAVEN CHILDREN'S HOSPITAL-WP-4TH FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2320
Practice Address - Fax:203-688-5426
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0407862080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001407867Medicaid
CT370001588Medicare ID - Type Unspecified
I36349Medicare UPIN