Gautam, Vibha G

Gautam, Vibha G is an sole proprietor health care provider with primary practice located at 393 Ocean Ave , New London CT 06320-4717. She recently has only one registered license in Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism, which is considered as her primary health care specialty. Gautam, Vibha G can be contacted via phone (860) 442-5976.

Contact Information

Primary practice address
393 Ocean Ave New London CT 06320-4717
Phone: (860) 442-5976
Fax: (860) 443-5055
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 021848 Connecticut

Profile Details

NPI number 1316042344
LBN Legal business name Gautam, Vibha G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 14th, 2006
Last updated Jul 8th, 2007 - about 17 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 1316042344 NPPES
Other XXX4692 AETNA
Other 50VGAUTAMCT01 AETNA
MEDICAID 1218486 AETNA
Other 0611346920001 AETNA
Other 218480 AETNA
Other OV1683 AETNA
Other SCNL008SCNL008 AETNA

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