Provider Demographics
NPI:1265497143
Name:KAGAOAN, GLADYS A (MD)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:A
Last Name:KAGAOAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-527-6247
Mailing Address - Fax:860-549-7936
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 4300
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-527-6247
Practice Address - Fax:860-549-7936
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT041548207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI08880Medicare UPIN