Provider Demographics
NPI:1053569533
Name:GARG, NAVEEN (MD)
Entity type:Individual
Prefix:DR
First Name:NAVEEN
Middle Name:
Last Name:GARG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 DE SALABERRY
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H9H 5B1
Mailing Address - Country:CA
Mailing Address - Phone:514-426-3200
Mailing Address - Fax:
Practice Address - Street 1:99 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1207
Practice Address - Country:US
Practice Address - Phone:718-825-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT049871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program