Basic Information
| Provider Information | |||||||||
| NPI: | 1649292947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARGANO | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 CORPORATE DR | ||||||||
| Address2: | SUITE 2-2 | ||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066111351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032688673 | ||||||||
| FaxNumber: | 2032688674 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 CORPORATE DR | ||||||||
| Address2: | SUITE 2-2 | ||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066111351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032688673 | ||||||||
| FaxNumber: | 2032688674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 16072 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1160720 | 05 | CT | MEDICAID |