Individual
GARY R WANERKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
784 E MAIN ST, BRANFORD, CT 06405-2918
(203) 481-7008
(203) 315-2712
Mailing address
784 E MAIN ST, BRANFORD, CT 06405-2918
(203) 481-7008
(203) 315-2712
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
013185
CT
2080P0201X
Pediatric Allergy/Immunology Physician
013185
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001131853
—
CT
Enumeration date
06/10/2006
Last updated
09/29/2011
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