Healthcare Provider Details

I. General information

NPI: 1396374708
Provider Name (Legal Business Name): EUGENE PETER WARNICK III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GINO PETER WARNICK III MD

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 HEBRON AVE STE 205
GLASTONBURY CT
06033-5003
US

IV. Provider business mailing address

622 HEBRON AVE STE 205
GLASTONBURY CT
06033-5003
US

V. Phone/Fax

Practice location:
  • Phone: 860-781-6294
  • Fax:
Mailing address:
  • Phone: 570-301-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number81169
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number81169
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: