MEDICARE: MEREDITH RAE GERSHON 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	207W00000X	Ophthalmology Physician	042196	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	:	1699746339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH RAE GERSHON MD

Provider Business Mailing Address
First Line	:	46 PRINCE ST STE 203
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06519-1600
Country	:	US
Telephone Number	:	203-787-6161
Fax Number	:	203-776-0300

Provider Business Practice Location Address
First Line	:	888 WHITE PLAINS RD STE 202
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-4552
Country	:	US
Telephone Number	:	203-365-6565
Fax Number	:	203-365-6567

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	09/08/2023

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