Organization
V G GAUTAM MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIBHA G GAUTAM (OWNER)
(860) 442-5976
Entity
Organization
Contact information
Practice address
393 OCEAN AVE, NEW LONDON, CT 06320-4717
(860) 442-5976
Mailing address
393 OCEAN AVE, NEW LONDON, CT 06320-4717
(860) 442-5976
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
021848
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001218486
—
CT
Enumeration date
07/11/2007
Last updated
07/11/2007
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