Healthcare Provider Details

I. General information

NPI: 1821364019
Provider Name (Legal Business Name): ELAN GORSHEIN DO, JD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2012
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YALE-NEW HAVEN SHORELINE MEDICAL CENTER 111 GOOSE LANE, SUITE 1300
GUILFORD CT
06437
US

IV. Provider business mailing address

YALE-NEW HAVEN SHORELINE MEDICAL CENTER 111 GOOSE LANE, SUITE 1300
GUILFORD CT
06437
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-9192
  • Fax:
Mailing address:
  • Phone: 203-453-9192
  • Fax: 203-453-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number60343
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number60343
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number60343
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: