Provider Demographics
NPI:1023211745
Name:GAVIN, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:GAVIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:50 NEW SCOTLAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3403
Mailing Address - Country:US
Mailing Address - Phone:518-262-6240
Mailing Address - Fax:518-262-4223
Practice Address - Street 1:50 NEW SCOTLAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3403
Practice Address - Country:US
Practice Address - Phone:518-262-6240
Practice Address - Fax:518-262-4223
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2022-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY244142207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02883094Medicaid
NY244142OtherNYS LICENSE
NY244142OtherNYS LICENSE