Provider Demographics
NPI:1720275704
Name:GARY J. PRICE, M.D., P.C.
Entity type:Organization
Organization Name:GARY J. PRICE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-453-6635
Mailing Address - Street 1:5 DURHAM RD
Mailing Address - Street 2:BLDG# 1, SUITE 8
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2076
Mailing Address - Country:US
Mailing Address - Phone:203-453-6635
Mailing Address - Fax:203-458-7580
Practice Address - Street 1:5 DURHAM RD
Practice Address - Street 2:BLDG# 1, SUITE 8
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2076
Practice Address - Country:US
Practice Address - Phone:203-453-6635
Practice Address - Fax:203-458-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023634174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001236348Medicaid
0Q1278OtherHEALTHNET
0982320OtherAETNA
CT010023634CT02OtherANTHEM BCBS
023634OtherCONNECTICARE
0Q1278OtherHEALTHNET
CTC59601Medicare UPIN
023634OtherCONNECTICARE