Provider Demographics
NPI:1003114398
Name:GREENWICH INTEGRATIVE MEDICINE PC
Entity Type:Organization
Organization Name:GREENWICH INTEGRATIVE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-863-3637
Mailing Address - Street 1:35 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2759
Mailing Address - Country:US
Mailing Address - Phone:203-863-3615
Mailing Address - Fax:203-863-4538
Practice Address - Street 1:35 RIVER RD
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2759
Practice Address - Country:US
Practice Address - Phone:203-863-3615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty