Active NPI
Gary R Wanerka, M.D.
- Pediatric Adolescent Medicine Physician
- Branford, CT
National Provider Identifier
1083655781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- 013185
- Practice address
- 784 E Main St
Branford, CT 06405-2918 - Phone
- (203) 481-7008
- Fax
- (203) 315-2712
- NPI assigned
- Jun 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | 013185 | CT | Primary |
| Pediatric Allergy/Immunology Physician | 2080P0201X | 013185 | CT |
Addresses
Primary practice location
784 E Main St
Branford, CT 06405-2918
Mailing address
784 E Main St
Branford, CT 06405-2918
Phone (203) 481-7008
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001131853 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013185 | CT | MD | Pediatric Allergy/Immunology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Branford Pediatrics & Allergy, P.C. | Adolescent Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Allergy Physician
- Branford, CT
- NPI 1851411169
Adolescent Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317254400000",
"number": "1083655781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "784 E MAIN ST",
"city": "BRANFORD",
"state": "CT",
"postal_code": "064052918",
"telephone_number": "203-481-7008",
"fax_number": "203-315-2712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "784 E MAIN ST",
"city": "BRANFORD",
"state": "CT",
"postal_code": "064052918",
"telephone_number": "203-481-7008",
"fax_number": "203-315-2712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANERKA",
"first_name": "GARY",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-10",
"last_updated": "2011-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "CT",
"license": "013185",
"primary": true
},
{
"code": "2080P0201X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Allergy/Immunology",
"state": "CT",
"license": "013185",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001131853",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Branford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.