Healthcare Provider Details

I. General information

NPI: 1871103663
Provider Name (Legal Business Name): SUSAN DENISE FITZGERALD ELY MD, MPHTM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CEDAR ST # B37K
NEW HAVEN CT
06510-3218
US

IV. Provider business mailing address

310 CEDAR ST # B37K
NEW HAVEN CT
06510-3218
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-3830
  • Fax:
Mailing address:
  • Phone: 203-785-3830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number204911
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number73089
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: