Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 032446 | CT |
NPI | 1437297785 |
---|---|
Provider Name | Mr. Gregory S Azia |
First Address | New London, CT 06320-4717 |
Second Address | New London, CT 06320-4717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 05/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001324467 | (05) | CT |
F33079 | (02) | CT |