Healthcare Provider Details

I. General information

NPI: 1417692997
Provider Name (Legal Business Name): GALEN ALEXANDER GOLDEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WAHOO AVE
GROTON CT
06349-2324
US

IV. Provider business mailing address

1 WAHOO AVE # 600
GROTON CT
06349-2324
US

V. Phone/Fax

Practice location:
  • Phone: 606-940-5212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0102208032
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102208032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: