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General NPI Number Information
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NPI Number | 1871103663
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Entity Type | Individual
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Provider Name | SUSAN DENISE FITZGERALD ELY MD, MPHTM
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Gender | Female
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 310 CEDAR ST # B37K
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City | NEW HAVEN
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State | CT
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Zip | 06510-3218
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Country | US
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Telephone | 203-785-3830
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Fax |
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Provider Business Mailing Address
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Address Line | 310 CEDAR ST # B37K
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City | NEW HAVEN
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State | CT
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Zip | 06510-3218
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Country | US
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Telephone | 203-785-3830
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZF0201X
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Taxonomy Name | Forensic Pathology Physician
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License Number | 204911
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 73089
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License Number State | CT
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