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General NPI Number Information
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NPI Number | 1336270727
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Entity Type | Organization
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Legal Business Name | STAMFORD INFECTIOUS DISEASES LLC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 166 WEST BROAD ST SUITE 202
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City | STAMFORD
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State | CT
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Zip | 06902
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Country | US
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Telephone | 203-353-1427
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Fax | 203-276-7597
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Provider Business Mailing Address
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Address Line | 166 WEST BROAD ST SUITE 202
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City | STAMFORD
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State | CT
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Zip | 06902
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Country | US
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Telephone | 203-353-1427
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Fax | 203-276-7597
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Authorized Official
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Title or Position | MEMBER MD
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Name | GAVIN X MCLEOD
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Credential | MD
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Telephone | 203-353-1427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State | CT
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