Individual
GREGORY MYRUS COLODNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
56 FRANKLIN ST, WATERBURY, CT 06706-1253
(203) 709-6000
Mailing address
56 FRANKLIN ST, 3RD FLOOR, WATERBURY, CT 06706-1221
(203) 709-6000
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
039369
CT
207RP1001X
Pulmonary Disease Physician
039369
CT
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
039369
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001393694
—
CT
01
—
010039369CT03
ANTHEM BCBS CT
CT
01
—
1169235
USA
CT
01
—
136130
WELLCARE
CT
01
—
3781279/5069527
AETNA
CT
Enumeration date
06/30/2006
Last updated
11/17/2021
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