Provider Demographics
NPI:1114192739
Name:NANCY LOUISE CARLSON GAMER, D.P.M.
Entity Type:Organization
Organization Name:NANCY LOUISE CARLSON GAMER, D.P.M.
Other - Org Name:NANCY CARLSON GAMER, D.P.M.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-834-1233
Mailing Address - Street 1:150 WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4527
Mailing Address - Country:US
Mailing Address - Phone:203-834-1233
Mailing Address - Fax:203-762-0472
Practice Address - Street 1:150 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4527
Practice Address - Country:US
Practice Address - Phone:203-834-1233
Practice Address - Fax:203-762-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00526213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004099372Medicaid
CT004099372Medicaid
CT480000432Medicare PIN