Provider Demographics
NPI:1245278472
Name:CZARNECKI, GREGORY R (DO)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
Last Name:CZARNECKI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:676 HEBRON AVENUE
Mailing Address - Street 2:HARTFORD MEDICAL GROUP
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:860-696-2250
Mailing Address - Fax:860-696-2260
Practice Address - Street 1:676 HEBRON AVENUE
Practice Address - Street 2:HARTFORD MEDICAL GROUP
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:860-696-2250
Practice Address - Fax:860-696-2260
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-01-11
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Provider Licenses
StateLicense IDTaxonomies
CT044289207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1245278472OtherNPI
CT1245278472OtherNPI