Provider Demographics
NPI:1154321768
Name:BULLER, GREGORY K (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:K
Last Name:BULLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 GRANT STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610
Mailing Address - Country:US
Mailing Address - Phone:203-384-3470
Mailing Address - Fax:203-384-4696
Practice Address - Street 1:850 STRAITS TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2843
Practice Address - Country:US
Practice Address - Phone:203-758-1800
Practice Address - Fax:203-758-1804
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027195207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001271957Medicaid
390000092Medicare ID - Type Unspecified
CT001271957Medicaid