Provider Demographics
NPI:1699212704
Name:GCNT LLC
Entity Type:Organization
Organization Name:GCNT LLC
Other - Org Name:GIAC-CHAN NGUYEN-TAN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:GIAC-CHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN-TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-848-7994
Mailing Address - Street 1:171 GRANDVIEW AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2517
Mailing Address - Country:US
Mailing Address - Phone:203-755-2214
Mailing Address - Fax:203-596-1133
Practice Address - Street 1:171 GRANDVIEW AVE
Practice Address - Street 2:STE 105
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2517
Practice Address - Country:US
Practice Address - Phone:203-755-2214
Practice Address - Fax:203-596-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028148207P00000X, 207PE0005X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty