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General NPI Number Information
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NPI Number | 1386616662
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Entity Type | Individual
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Provider Name | GAVIN X MCLEOD MD
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 166 W BROAD ST STE 202
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City | STAMFORD
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State | CT
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Zip | 06902-3661
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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 | 5 PERRYRIDGE RD
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City | GREENWICH
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State | CT
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Zip | 06830-4608
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Country | US
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Telephone | 203-517-8194
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Fax | 203-863-3262
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 033027
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 033027
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License Number State | CT
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