Healthcare Provider Details

I. General information

NPI: 1063824407
Provider Name (Legal Business Name): NICOLE GAVIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ALBINO M.D.

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 11/07/2022
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-8085
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-8085
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2329
  • Fax: 860-679-1494
Mailing address:
  • Phone: 860-679-2329
  • Fax: 860-679-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD85949
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number067620
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: