Provider Demographics
NPI:1770524753
Name:FUMO, GERARD (DO)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:FUMO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LUNAR DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2320
Mailing Address - Country:US
Mailing Address - Phone:203-389-7504
Mailing Address - Fax:203-389-8854
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-238-7747
Practice Address - Fax:203-686-6282
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041938207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001419383Medicaid
H98625Medicare UPIN
CT90000027Medicare ID - Type Unspecified