Healthcare Provider Details

I. General information

NPI: 1780680884
Provider Name (Legal Business Name): LAURENTIU P GALAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

119 SACHEM ST
NORWICH CT
06360-4128
US

IV. Provider business mailing address

119 SACHEM ST
NORWICH CT
06360-4128
US

V. Phone/Fax

Practice location:
  • Phone: 860-885-0666
  • Fax: 860-885-1158
Mailing address:
  • Phone: 860-885-0666
  • Fax: 860-885-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number035967
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: