Healthcare Provider Details

I. General information

NPI: 1518176387
Provider Name (Legal Business Name): ELISE KATHLEEN GATES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 SAYBROOK RD
MIDDLETOWN CT
06457-4711
US

IV. Provider business mailing address

28 CRESCENT ST
MIDDLETOWN CT
06457-3650
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-2850
  • Fax: 860-358-8698
Mailing address:
  • Phone: 860-358-6000
  • Fax: 603-668-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number052083
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19124
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number052083
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: