Provider Demographics
NPI:1285673145
Name:OLIVER, GARTH (MD)
Entity type:Individual
Prefix:DR
First Name:GARTH
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 SAVIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4933
Mailing Address - Country:US
Mailing Address - Phone:203-932-2400
Mailing Address - Fax:203-932-2401
Practice Address - Street 1:603 SAVIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4933
Practice Address - Country:US
Practice Address - Phone:203-932-2400
Practice Address - Fax:203-932-2401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010035510CT01OtherANTHEM BCBS
CT5817459OtherAETNA
CT2V4111OtherHEALTHNET
CT001355107-03OtherBLUE CARE FAMILY PLAN
CTP449063OtherOXFORD
CT001355107-03OtherBLUE CARE FAMILY PLAN