Provider Demographics
NPI:1528367026
Name:GOSPIN, REBEKAH MARA (MD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MARA
Last Name:GOSPIN
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 1:292 LONG RIDGE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1627
Mailing Address - Country:US
Mailing Address - Phone:203-276-7213
Mailing Address - Fax:203-276-4975
Practice Address - Street 1:292 LONG RIDGE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1627
Practice Address - Country:US
Practice Address - Phone:203-276-7213
Practice Address - Fax:203-276-4975
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT55035207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism