Individual
VIBHA G GAUTAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
393 OCEAN AVE, NEW LONDON, CT 06320-4717
(860) 442-5976
(860) 443-5055
Mailing address
393 OCEAN AVE, NEW LONDON, CT 06320-4717
(860) 442-5976
(860) 443-5055
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
021848
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0611346920001
CIGNA
—
05
—
1218486
—
CT
01
—
218480
CONNECTICARE
—
01
—
50VGAUTAMCT01
BLUE CROSS BLUE SHIELD
—
01
—
OV1683
HEALTH NET
—
01
—
SCNL008SCNL008
OXFORD HEALTH
—
01
—
XXX4692
AETNA
—
Enumeration date
09/14/2006
Last updated
07/08/2007
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