Provider Demographics
NPI:1619012085
Name:GAUVIN, MILA (MD)
Entity type:Individual
Prefix:
First Name:MILA
Middle Name:
Last Name:GAUVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SCHUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3730
Mailing Address - Country:US
Mailing Address - Phone:203-327-1187
Mailing Address - Fax:
Practice Address - Street 1:51 SCHUYLER AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3730
Practice Address - Country:US
Practice Address - Phone:203-327-1187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT81429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02583168Medicaid
NY00695941Medicaid
NY02583168Medicaid