Healthcare Provider Details

I. General information

NPI: 1023465283
Provider Name (Legal Business Name): LEAH ELLEN GREGORIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E HIGH ST
EAST HAMPTON CT
06424-1099
US

IV. Provider business mailing address

90 S MAIN ST
MIDDLETOWN CT
06457-3649
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-6486
  • Fax:
Mailing address:
  • Phone: 860-358-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number63738
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: