Healthcare Provider Details

I. General information

NPI: 1144130022
Provider Name (Legal Business Name): PRIMECARE FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 NORTH ST STE 422423
DANBURY CT
06810-5660
US

IV. Provider business mailing address

57 NORTH ST STE 422423
DANBURY CT
06810-5660
US

V. Phone/Fax

Practice location:
  • Phone: 203-746-2436
  • Fax: 203-746-3205
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMENTHA GILLES
Title or Position: MANAGING MEMBER
Credential: NP
Phone: 203-343-8077