Provider Demographics
NPI:1942294772
Name:GAGNE, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GAGNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BOSTON POST RD STE 240
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-3600
Mailing Address - Country:US
Mailing Address - Phone:203-548-7858
Mailing Address - Fax:203-502-2615
Practice Address - Street 1:330 BOSTON POST RD STE 240
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-3600
Practice Address - Country:US
Practice Address - Phone:203-548-7858
Practice Address - Fax:203-439-4839
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0451062086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1942294772Medicaid
CT1942294772Medicaid
CT770000079Medicare PIN