Healthcare Provider Details

I. General information

NPI: 1508819749
Provider Name (Legal Business Name): THOMAS VINCENT GOCKE III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOM GOCKE PA-C

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-4038
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-4038
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-6600
  • Fax: 860-679-6604
Mailing address:
  • Phone: 860-679-6600
  • Fax: 860-679-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number690
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003817
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: