Provider Demographics
NPI:1144211616
Name:PRICE, GARY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:PRICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:J
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-0368
Mailing Address - Country:US
Mailing Address - Phone:203-453-6635
Mailing Address - Fax:203-458-7580
Practice Address - Street 1:5 DURHAM RD
Practice Address - Street 2:BLDG# 1, SUITE 8
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2076
Practice Address - Country:US
Practice Address - Phone:203-453-6635
Practice Address - Fax:203-458-7580
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023634208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
061181566-002OtherCIGNA
0Q1278OtherHEALTHNET ACESSCODE932781
982320OtherAETNA
061181566OtherUNITED HEALTH CARE
240001033OtherRAILROAD MEDICARE
023634OtherCONNECTICARE
023634OtherCONNECTICARE 65
061181566OtherMEDSPAN
C45753690OtherNATIONAL GRAGE MUTUAL INC
NHS527OtherOXFORD & OXFORD MEDICARE
010023634CT02OtherANTHEM BCBS
0Q1278OtherHEALTHNET ACESSCODE932781
061181566OtherMEDSPAN