Basic Information
| Provider Information | |||||||||
| NPI: | 1275581621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GINGOLD | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 499 FARMINGTON AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060321943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606780202 | ||||||||
| FaxNumber: | 8606780224 | ||||||||
| Practice Location | |||||||||
| Address1: | 499 FARMINGTON AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060321943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606780202 | ||||||||
| FaxNumber: | 8606780224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 029360 | CT | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | P00188931 | 01 | RAILROAD MEDICARE | OTHER | 001293604 | 05 | CT | MEDICAID |