Individual
DR. GARY W. THEALL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 RONALD REAGAN BLVD, WARWICK, NY 10990-4105
(845) 986-4949
(845) 986-9388
Mailing address
PO BOX 350, WARWICK, NY 10990-0350
(845) 986-4949
(845) 986-9388
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
1817741
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01184569
—
NY
Enumeration date
08/29/2005
Last updated
07/09/2007
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