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General NPI Number Information
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NPI Number | 1871837971
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Entity Type | Organization
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Legal Business Name | GREENWICH PURE MEDICAL, LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 15 VALLEY DR
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City | GREENWICH
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State | CT
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Zip | 06831-5205
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Country | US
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Telephone | 203-869-2800
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Fax | 203-869-2803
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Provider Business Mailing Address
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Address Line | 15 VALLEY DR
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City | GREENWICH
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State | CT
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Zip | 06831-5205
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Country | US
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Telephone | 203-869-2800
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Fax | 203-869-2803
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Authorized Official
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Title or Position | OWNER
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Name | DR. SARAH MILDRED GAMBLE
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Credential | D.O
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Telephone | 203-278-2800
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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 | 045358
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License Number State | CT
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