Healthcare Provider Details

I. General information

NPI: 1720275704
Provider Name (Legal Business Name): GARY J. PRICE, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DURHAM RD BLDG# 1, SUITE 8
GUILFORD CT
06437-2076
US

IV. Provider business mailing address

5 DURHAM RD BLDG# 1, SUITE 8
GUILFORD CT
06437-2076
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-6635
  • Fax: 203-458-7580
Mailing address:
  • Phone: 203-453-6635
  • Fax: 203-458-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number023634
License Number StateCT

VIII. Authorized Official

Name: DR. GARY J. PRICE
Title or Position: PRESIDENT / DIRECTOR
Credential: M.D.
Phone: 203-453-6635