Provider Demographics
NPI:1992775910
Name:ROY, GERARD M (MD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:M
Last Name:ROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GROVE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-4116
Mailing Address - Country:US
Mailing Address - Phone:860-224-2447
Mailing Address - Fax:860-826-5845
Practice Address - Street 1:1 GROVE ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053
Practice Address - Country:US
Practice Address - Phone:860-224-2447
Practice Address - Fax:860-826-5845
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036822207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004393922Medicaid
CTG60378Medicare UPIN
CT004393922Medicaid