Provider Demographics
NPI:1124008610
Name:GONSIOR, ELAINE CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:CATHERINE
Last Name:GONSIOR
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 1:5751 SONNET HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8117
Mailing Address - Country:US
Mailing Address - Phone:719-520-5613
Mailing Address - Fax:
Practice Address - Street 1:5751 SONNET HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8117
Practice Address - Country:US
Practice Address - Phone:719-520-5613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13193174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODAD-000Medicare ID - Type Unspecified