Healthcare Provider Details

I. General information

NPI: 1144211616
Provider Name (Legal Business Name): GARY J PRICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GARY J PRICE MD

II. Dates (important events)

Enumeration Date: 11/02/2005
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

PO BOX 368
GUILFORD CT
06437-0368
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 Code208200000X
TaxonomyPlastic Surgery Physician
License Number023634
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: