1861437477 NPI number — DR. GERARD GEORGE GAGNE JR. M.D.

Table of content: DR. GERARD GEORGE GAGNE JR. M.D. (NPI 1861437477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861437477 NPI number — DR. GERARD GEORGE GAGNE JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAGNE
Provider First Name:
GERARD
Provider Middle Name:
GEORGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAGNE
Provider Other First Name:
GERRY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1861437477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
287 BILTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERS
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06071-1044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-763-8716
Provider Business Mailing Address Fax Number:
860-763-8779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
287 BILTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERS
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06071-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-763-8716
Provider Business Practice Location Address Fax Number:
860-763-8779
Provider Enumeration Date:
06/18/2006

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: 2084P0800X , with the licence number:  MD046464 , 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)





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