Healthcare Provider Details

I. General information

NPI: 1033190731
Provider Name (Legal Business Name): GREGORY R GADOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BELMONT AVE
BRATTLEBORO VT
05301-7109
US

IV. Provider business mailing address

19 BELMONT AVE
BRATTLEBORO VT
05301-7109
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-2277
  • Fax: 802-257-2270
Mailing address:
  • Phone: 802-257-2277
  • Fax: 802-257-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number042-0009111
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: