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General NPI Number Information
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NPI Number | 1184839128
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Entity Type | Organization
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Legal Business Name | GUARDIAN HEALTH CENTER, PA
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Dates
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Enumeration Date | 05/12/2007
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 179 FLANDERS RD
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City | NIANTIC
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State | CT
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Zip | 06357-1206
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Country | US
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Telephone | 860-949-3040
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Fax |
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Provider Business Mailing Address
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Address Line | 179 FLANDERS RD
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City | NIANTIC
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State | CT
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Zip | 06357-1206
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Country | US
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Telephone | 860-949-3040
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TROY FRAZER
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Credential | D.O.
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Telephone | 860-949-3040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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