Basic Information
| Provider Information | |||||||||
| NPI: | 1356380232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANSINO | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 LUNAR DR | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065252320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033897504 | ||||||||
| FaxNumber: | 2033891666 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 LEWIS AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MERIDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064512121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032387747 | ||||||||
| FaxNumber: | 2036860282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 08/09/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 028168 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 001281683 | 05 | CT | MEDICAID |