MEDICARE: DR. SAMUEL GETTLER 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	207N00000X	Dermatology Physician	044013	CT

General Provider Information

NPI Number	:	1841221264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL GETTLER MD

Provider Business Mailing Address
First Line	:	23 HOYT ST
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5604
Country	:	US
Telephone Number	:	203-323-3376
Fax Number	:	203-504-6374

Provider Business Practice Location Address
First Line	:	23 HOYT ST
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5604
Country	:	US
Telephone Number	:	203-323-3376
Fax Number	:	203-504-6374

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	09/28/2012

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