Provider Demographics
NPI:1407943392
Name:DYCHIAO, GLADYS G (MD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:G
Last Name:DYCHIAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-3408
Mailing Address - Country:US
Mailing Address - Phone:860-889-7321
Mailing Address - Fax:860-889-7805
Practice Address - Street 1:26 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-3408
Practice Address - Country:US
Practice Address - Phone:860-889-7321
Practice Address - Fax:860-889-7805
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043040207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001430404Medicaid