Healthcare Provider Details

I. General information

NPI: 1730160987
Provider Name (Legal Business Name): SUSAN E.M. GOBEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WHITNEY AVE SUITE 360
HAMDEN CT
06518-3691
US

IV. Provider business mailing address

2200 WHITNEY AVE SUITE 360
HAMDEN CT
06518-3691
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-4463
  • Fax: 203-287-2930
Mailing address:
  • Phone: 203-281-4463
  • Fax: 203-287-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number028470
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number028470
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: