Individual
DR. GORDON CHASE STREETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LOCK ST, NEW HAVEN, CT 06511-3603
(203) 432-0206
(203) 432-0072
Mailing address
PO BOX 208237, YALE UNIVERISTY, NEW HAVEN, CT 06520-8237
(203) 432-0206
(203) 432-0072
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
043348
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001433482
—
CT
01
—
010043348CT01
BCBS
CT
01
—
061511900
FED TAX ID
CT
Enumeration date
03/27/2006
Last updated
10/06/2016
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