Provider Demographics
NPI:1588740757
Name:GEWIRTZ, JOAN T (MD)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:T
Last Name:GEWIRTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:70 MILL RIVER ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3725
Mailing Address - Country:US
Mailing Address - Phone:203-348-0868
Mailing Address - Fax:203-975-5286
Practice Address - Street 1:70 MILL RIVER ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3725
Practice Address - Country:US
Practice Address - Phone:203-348-0868
Practice Address - Fax:203-975-5286
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028538207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001285386Medicaid
CT001285386Medicaid
CT180000329Medicare ID - Type Unspecified