Provider Demographics
NPI:1679505697
Name:GILLETTE, MARY E (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:GILLETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:60 WASHINGTON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3271
Mailing Address - Country:US
Mailing Address - Phone:203-230-2939
Mailing Address - Fax:203-287-1845
Practice Address - Street 1:60 WASHINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3271
Practice Address - Country:US
Practice Address - Phone:203-230-2939
Practice Address - Fax:203-287-1845
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021978207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001219781Medicaid
CT160000922Medicare ID - Type Unspecified
CTE27724Medicare UPIN