Provider Information for 1063824407
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NICOLE GAVIN M.D.
Other Names:Former Name:NICOLE ALBINO M.D.Sex: Female
NPI: 1063824407
Last Updated: 2022-11-07
Certification Date: 2021-08-12
Certification Date: 2021-08-12
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1063824407 | ||||||||||||||
| Enumeration Date | 2014-05-20 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-8085 United States Phone: 860-679-2329 | Fax:860-679-1494 | ||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-8085 United States Phone: 860-679-2329 | Fax:860-679-1494 | ||||||||||||||
| Secondary Practice Address(es) | 1800 ORLEANS ST | ||||||||||||||
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