1144211616 NPI number — DR. GARY J PRICE MD

Table of content: DR. GARY J PRICE MD (NPI 1144211616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144211616 NPI number — DR. GARY J PRICE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
GARY
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRICE
Provider Other First Name:
GARY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144211616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06437-0368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-453-6635
Provider Business Mailing Address Fax Number:
203-458-7580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 DURHAM RD
Provider Second Line Business Practice Location Address:
BLDG# 1, SUITE 8
Provider Business Practice Location Address City Name:
GUILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06437-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-453-6635
Provider Business Practice Location Address Fax Number:
203-458-7580
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  023634 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 061181566-002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0Q1278 . This is a "HEALTHNET ACESSCODE932781" identifier . This identifiers is of the category "OTHER".
  • Identifier: 982320 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061181566 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 240001033 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 023634 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 023634 . This is a "CONNECTICARE 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061181566 . This is a "MEDSPAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: C45753690 . This is a "NATIONAL GRAGE MUTUAL INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: NHS527 . This is a "OXFORD & OXFORD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010023634CT02 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".




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