Individual
SAMUEL W. GASTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 679-2290
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
000828
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316003908
—
CT
Enumeration date
12/28/2006
Last updated
09/20/2022
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