Provider Demographics
NPI:1649292947
Name:GARGANO, PAUL ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDREW
Last Name:GARGANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 CORPORATE DR
Mailing Address - Street 2:SUITE 2-2
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1351
Mailing Address - Country:US
Mailing Address - Phone:203-268-8673
Mailing Address - Fax:203-268-8674
Practice Address - Street 1:15 CORPORATE DR
Practice Address - Street 2:SUITE 2-2
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1351
Practice Address - Country:US
Practice Address - Phone:203-268-8673
Practice Address - Fax:203-268-8674
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT16072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1160720Medicaid
CTB83165Medicare UPIN
CT1160720Medicaid