MEDICARE: DR. SUSAN STOCKER GILES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	031879	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538132246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN STOCKER GILES MD

Provider Business Mailing Address
First Line	:	515 MIDDLE TPKE W
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06040-3816
Country	:	US
Telephone Number	:	860-432-8400
Fax Number	:	860-432-8430

Provider Business Practice Location Address
First Line	:	1000 ASYLUM AVE STE 2115
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1719
Country	:	US
Telephone Number	:	860-714-4000
Fax Number	:	860-714-8612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2006
Last Update Date	:	11/12/2021

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