Provider Demographics
NPI:1669550851
Name:GEWIRTZ, HAROLD S (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:S
Last Name:GEWIRTZ
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 1:70 MILL RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-325-1381
Mailing Address - Fax:203-975-5286
Practice Address - Street 1:70 MILL RIVER STREET
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-325-1381
Practice Address - Fax:203-975-5286
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023598208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
240000045Medicare ID - Type Unspecified
B83138Medicare UPIN