Provider Demographics
NPI:1053382978
Name:FENNELL, GAIL ELIZABETH MORANDI (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ELIZABETH MORANDI
Last Name:FENNELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:90 S RIDGE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2811
Mailing Address - Country:US
Mailing Address - Phone:914-305-9098
Mailing Address - Fax:914-481-1402
Practice Address - Street 1:90 S RIDGE ST STE 201
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2811
Practice Address - Country:US
Practice Address - Phone:914-305-9098
Practice Address - Fax:914-481-1402
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY294475-1207R00000X
CT034225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110005690Medicare ID - Type UnspecifiedMEDICARE
CTG01578Medicare UPIN