MEDICARE: DR. GAD LAVY M.D.

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	207VE0102X	Reproductive Endocrinology Physician	26219	CT

General Provider Information

NPI Number	:	1760451090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAD LAVY M.D.

Provider Business Mailing Address
First Line	:	1275 SUMMER ST STE 201
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5315
Country	:	US
Telephone Number	:	203-325-3200
Fax Number	:	203-323-3130

Provider Business Practice Location Address
First Line	:	1275 SUMMER ST
Second Line	:	SUITE 201
City	:	STAMFORD
State	:	CT
Zip	:	06905-5359
Country	:	US
Telephone Number	:	203-325-3200
Fax Number	:	203-323-3130

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	11/07/2024

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