Healthcare Provider Details

I. General information

NPI: 1275092314
Provider Name (Legal Business Name): MICHAEL GHIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

PO BOX 208062
NEW HAVEN CT
06520-8062
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2572
  • Fax:
Mailing address:
  • Phone: 203-785-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number24475175
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: