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Individual

MR. GARY C VESCERA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
HIS

Contact information

Practice address
620 W MAIN ST, MERIDEN, CT 06451-2767
(203) 634-1338
Mailing address
9 SUMMITT RD, PROSPECT, CT 06712
(203) 574-5377

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
365
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004242632
CT
Enumeration date
01/29/2007
Last updated
12/02/2010
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