Individual
GAVIN MICHAEL HANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 533-4679
Mailing address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 533-4679
(860) 645-4151
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO3611
ME
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/15/2020
Last updated
07/20/2023
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