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General NPI Number Information
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NPI Number | 1609075639
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Entity Type | Organization
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Legal Business Name | V G GAUTAM MD PC
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 393 OCEAN AVE
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City | NEW LONDON
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State | CT
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Zip | 06320-4717
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Country | US
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Telephone | 860-442-5976
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Fax |
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Provider Business Mailing Address
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Address Line | 393 OCEAN AVE
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City | NEW LONDON
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State | CT
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Zip | 06320-4717
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Country | US
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Telephone | 860-442-5976
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIBHA G GAUTAM
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Credential |
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Telephone | 860-442-5976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 021848
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License Number State | CT
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