Provider Demographics
NPI:1265445050
Name:GAMBARDELLA, PAUL T (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:GAMBARDELLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:329 MAIN ST
Mailing Address - Street 2:UNIT 110
Mailing Address - City:YALESVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2279
Mailing Address - Country:US
Mailing Address - Phone:203-265-6677
Mailing Address - Fax:203-294-9784
Practice Address - Street 1:329 MAIN ST
Practice Address - Street 2:UNIT 110
Practice Address - City:YALESVILLE
Practice Address - State:CT
Practice Address - Zip Code:06492-2279
Practice Address - Country:US
Practice Address - Phone:203-265-6677
Practice Address - Fax:203-294-9784
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000547213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
030000547CT02OtherBCBS
CT004114500Medicaid
CT0934940002Medicare NSC
CT004114500Medicaid
CT48000472Medicare PIN