Physician Compare National (NPI:1104929702)

HEALTHCARE PROVIDER: GARY R ITALIA DC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1104929702
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2365464237
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111121000185
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ITALIA
	Individual professional last name
Provider First Name	GARY
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NATIONAL COLLEGE OF CHIROPRACTIC
	Individual professional's medical school
Graduation Year	1988
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2080 SILAS DEANE HWY
	Group Practice or individual's line 1 address
Line 2 Street Address	FL 3
	Group Practice or individual's line 2 address
City	ROCKY HILL
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	060672334
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y