Provider Demographics
NPI:1508879685
Name:GAONA, ROSALINDA G (MD)
Entity Type:Individual
Prefix:
First Name:ROSALINDA
Middle Name:G
Last Name:GAONA
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 1:10 LIBERTY WAY B10
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1033
Mailing Address - Country:US
Mailing Address - Phone:860-691-8084
Mailing Address - Fax:
Practice Address - Street 1:10 LIBERTY WAY UNIT B10
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1033
Practice Address - Country:US
Practice Address - Phone:860-691-8084
Practice Address - Fax:860-691-1195
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042084207R00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4024972Medicaid
CT4041679Medicaid
RIRD89190Medicaid
I01637Medicare UPIN
RIRD89190Medicaid