=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063974020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL ELAINE GILBERT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2019
-----------------------------------------------------
Last Update Date | 05/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 ALBANY TPKE
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06019-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-658-3444
-----------------------------------------------------
Fax | 860-658-3457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 263 FARMINGTON AVE
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06030-8082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-658-3444
-----------------------------------------------------
Fax | 860-679-3457
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 332873
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 073739
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------