MEDICARE: DR. DAVID R GRUEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	036693	CT

General Provider Information

NPI Number	:	1215901327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID R GRUEN MD

Provider Business Mailing Address
First Line	:	32 STRAWBERRY HILL CT
Second Line	:	2ND FLOOR WOMEN'S CENTER
City	:	STAMFORD
State	:	CT
Zip	:	06902-2594
Country	:	US
Telephone Number	:	203-276-4152
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 STRAWBERRY HILL CT
Second Line	:	2ND FLOOR WOMEN'S CENTER
City	:	STAMFORD
State	:	CT
Zip	:	06902-2594
Country	:	US
Telephone Number	:	203-276-4152
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	10/15/2019

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