Healthcare Provider Details

I. General information

NPI: 1669578175
Provider Name (Legal Business Name): ROBERT GENNARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SHELBURNE RD OBGYN ASSOCIATES, PC
STAMFORD CT
06902-3628
US

IV. Provider business mailing address

12 CAMBRIDGE DR CREDENTIALS XPRESS
TRUMBULL CT
06611-4764
US

V. Phone/Fax

Practice location:
  • Phone: 203-276-7060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number028989
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: