Fosdick, Gordon E

Fosdick, Gordon E is an individual health care provider with primary practice located at 470 Main St , Middlefield CT 06455-1210. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot Surgery, which is considered as his primary health care specialty. Fosdick, Gordon E can be contacted via phone (860) 349-8500.

Contact Information

Primary practice address
470 Main St Middlefield CT 06455-1210
Phone: (860) 349-8500
Fax: (860) 349-3081
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X 00723 Connecticut

Profile Details

NPI number 1740206192
LBN Legal business name Fosdick, Gordon E
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 15th, 2006
Last updated Jun 26th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740206192 NPPES
Connecticut Other 000723 CONNECTICARE
Connecticut Other 030000723CT05 CONNECTICARE
Connecticut MEDICAID 004206951 CONNECTICARE

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