Provider Demographics
NPI:1386616662
Name:MCLEOD, GAVIN X (MD)
Entity type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:X
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5 PERRYRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4608
Mailing Address - Country:US
Mailing Address - Phone:203-517-8194
Mailing Address - Fax:203-863-3262
Practice Address - Street 1:166 W BROAD ST
Practice Address - Street 2:STE 202
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3661
Practice Address - Country:US
Practice Address - Phone:203-353-1427
Practice Address - Fax:203-276-7597
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033027207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001330274Medicaid