Provider Demographics
NPI:1609875491
Name:GAVIN, JAMES PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:GAVIN
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 1:7 CAMBRIDGE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4763
Mailing Address - Country:US
Mailing Address - Phone:203-335-0195
Mailing Address - Fax:203-335-7293
Practice Address - Street 1:7 CAMBRIDGE DR STE 201
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4763
Practice Address - Country:US
Practice Address - Phone:203-335-0195
Practice Address - Fax:203-335-7293
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033143207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001331438Medicaid
CTE87003Medicare UPIN
CT390000104Medicare ID - Type Unspecified
CT390004981Medicare PIN