Provider Demographics
NPI:1326155110
Name:GAMER, NANCY L (DPM)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
Last Name:GAMER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000526213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT480011998OtherPALMETTO GBA- RAILROAD M
CT004099372Medicaid
CT480011998OtherPALMETTO GBA- RAILROAD M
CTT95387Medicare UPIN
CT480000432Medicare ID - Type Unspecified