Provider Demographics
NPI:1437297785
Name:AZIA, GREGORY S (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:S
Last Name:AZIA
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 1:399 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4717
Mailing Address - Country:US
Mailing Address - Phone:860-443-3202
Mailing Address - Fax:860-443-7350
Practice Address - Street 1:399 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4717
Practice Address - Country:US
Practice Address - Phone:860-443-3202
Practice Address - Fax:860-443-7350
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032446204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001324467Medicaid
CT001324467Medicaid
CTF33079Medicare UPIN