Provider Demographics
NPI:1871837971
Name:GREENWICH PURE MEDICAL, LLC
Entity Type:Organization
Organization Name:GREENWICH PURE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-278-2800
Mailing Address - Street 1:15 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5205
Mailing Address - Country:US
Mailing Address - Phone:203-869-2800
Mailing Address - Fax:203-869-2803
Practice Address - Street 1:15 VALLEY DR
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5205
Practice Address - Country:US
Practice Address - Phone:203-869-2800
Practice Address - Fax:203-869-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty