Provider Demographics
NPI:1740410927
Name:FABRY, GERALD ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ROY
Last Name:FABRY
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 1:65 SPICER HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1334
Mailing Address - Country:US
Mailing Address - Phone:860-464-9185
Mailing Address - Fax:860-464-9185
Practice Address - Street 1:65 SPICER HILL RD
Practice Address - Street 2:
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339-1334
Practice Address - Country:US
Practice Address - Phone:860-464-9185
Practice Address - Fax:860-464-9185
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018707208600000X
MI4301036751208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery