Provider Demographics
NPI:1861437477
Name:GAGNE, GERARD GEORGE JR (MD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:GEORGE
Last Name:GAGNE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GERRY
Other - Middle Name:
Other - Last Name:GAGNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:287 BILTON RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-1044
Mailing Address - Country:US
Mailing Address - Phone:860-763-8716
Mailing Address - Fax:860-763-8779
Practice Address - Street 1:287 BILTON RD
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-1044
Practice Address - Country:US
Practice Address - Phone:860-763-8716
Practice Address - Fax:860-763-8779
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTMD0464642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7057360Medicaid
RI27704-4OtherRI BLUE CROSS
RII25692Medicare UPIN
RI31386-7OtherRI BLUE SHIELD
RI15-28753OtherRI UNITED HEALTH
RI412412OtherRI BLUE CHIP