Provider Demographics
NPI:1487649570
Name:GABOW, ANDREW G (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:G
Last Name:GABOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3123
Mailing Address - Country:US
Mailing Address - Phone:860-243-1414
Mailing Address - Fax:860-286-0510
Practice Address - Street 1:510 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3123
Practice Address - Country:US
Practice Address - Phone:860-243-1414
Practice Address - Fax:860-286-0510
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033861207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001338616Medicaid
0384440001OtherDMERC
200031060OtherRAILROAD MEDICARE
F90902Medicare UPIN
200031060OtherRAILROAD MEDICARE