Healthcare Provider Details

I. General information

NPI: 1346271749
Provider Name (Legal Business Name): GORDON STROTHERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LONG WHARF DR SUITE 302
NEW HAVEN CT
06511-5991
US

IV. Provider business mailing address

1 LONG WHARF DR SUITE 302
NEW HAVEN CT
06511-5991
US

V. Phone/Fax

Practice location:
  • Phone: 860-664-0126
  • Fax: 203-776-7741
Mailing address:
  • Phone: 860-664-0126
  • Fax: 203-776-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number16710
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number16710
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number16710
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: