Healthcare Provider Details

I. General information

NPI: 1598720781
Provider Name (Legal Business Name): ADAM A GALLUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHESTNUT HILL RD
STAFFORD SPRINGS CT
06076-4005
US

IV. Provider business mailing address

99 E RIVER DR 5TH FLOOR
EAST HARTFORD CT
06108-3288
US

V. Phone/Fax

Practice location:
  • Phone: 860-684-8424
  • Fax: 860-684-8460
Mailing address:
  • Phone: 860-282-4123
  • Fax: 860-282-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54183
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: