Provider Demographics
NPI:1427016849
Name:BUFFO, GERARD CHARLES (MD FACR)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:CHARLES
Last Name:BUFFO
Suffix:
Gender:M
Credentials:MD FACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070
Mailing Address - Country:US
Mailing Address - Phone:860-651-3355
Mailing Address - Fax:860-408-9648
Practice Address - Street 1:540 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070
Practice Address - Country:US
Practice Address - Phone:860-651-3355
Practice Address - Fax:860-408-9648
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4624942085R0202X
CT0278752085R0202X, 2085R0204X, 208D00000X
NY1603302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001278753Medicaid
CT001278753Medicaid
CTB37911Medicare UPIN