Provider Demographics
NPI:1003078379
Name:GOZZO, YEISID F (MD)
Entity Type:Individual
Prefix:DR
First Name:YEISID
Middle Name:F
Last Name:GOZZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 AMHERST DR
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1606
Mailing Address - Country:US
Mailing Address - Phone:203-271-3935
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:DEPT OF NEONATOLOGY
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0466182080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT98900-5912OtherCONNECTICARE
CT2V9573OtherHEALTHNET/COMMERCIAL
CTP00359922OtherRR MEDICARE
CT290000989CT03OtherANTHEM BCBS CT
CT1064653OtherUSA
CT26-33542OtherAMERICHOICE
CT26-33542OtherUHC
CTP3412840OtherOXFORD
CT357229OtherWELLCARE
CT7061719OtherAETNA
CT1064653OtherUSA
CTD400009339Medicare PIN