Individual
ANTHONY J GERVASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
159 TROUT AVE, GROTON, CT 06340
(860) 694-6450
Mailing address
15 GREENWOOD ST, GROTON, CT 06340-2521
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
07/19/2017
Last updated
07/19/2017
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