Provider Demographics
NPI:1740298322
Name:YACONO, GARY THOMAS (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:THOMAS
Last Name:YACONO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:130 STATE ROUTE 37
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-4013
Mailing Address - Country:US
Mailing Address - Phone:203-746-6000
Mailing Address - Fax:203-746-0155
Practice Address - Street 1:130 STATE ROUTE 37
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-4013
Practice Address - Country:US
Practice Address - Phone:203-746-6000
Practice Address - Fax:203-746-0155
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT026624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB83169Medicare UPIN