Healthcare Provider Details

I. General information

NPI: 1023019726
Provider Name (Legal Business Name): LEONARD E GRAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 WHITNEY AVE
HAMDEN CT
06517-1209
US

IV. Provider business mailing address

1952 WHITNEY AVE
HAMDEN CT
06517-1209
US

V. Phone/Fax

Practice location:
  • Phone: 203-773-3055
  • Fax: 203-281-5796
Mailing address:
  • Phone: 203-773-3055
  • Fax: 203-281-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13960
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: