Healthcare Provider Details

I. General information

NPI: 1003114398
Provider Name (Legal Business Name): GREENWICH INTEGRATIVE MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 RIVER RD
COS COB CT
06807-2759
US

IV. Provider business mailing address

35 RIVER RD
COS COB CT
06807-2759
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3615
  • Fax:
Mailing address:
  • Phone: 203-863-3615
  • Fax: 203-863-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN DORAN
Title or Position: OFFICER
Credential: MD
Phone: 203-863-3637