Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 001133 | CT |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 6561 | CT |
NPI | 1114961703 |
---|---|
Provider Name | Dr. Andrew Paul Thomas Gregory |
First Address | Vernon, CT 06066-4845 |
Second Address | Vernon, CT 06066-4845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 12/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U55233 | (02) | CT |