Provider Demographics
NPI:1558330720
Name:NEUHAUS, ELLEN GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:GAIL
Last Name:NEUHAUS
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 1:145 UNION STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3025
Mailing Address - Country:US
Mailing Address - Phone:860-872-5158
Mailing Address - Fax:860-872-5626
Practice Address - Street 1:145 UNION ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3025
Practice Address - Country:US
Practice Address - Phone:860-872-5158
Practice Address - Fax:860-872-5626
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT22060207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010022060CT03OtherANTHEM
CT4025029Medicaid
CT001220607-CLOtherBLUE CARE FAMILY
CT4041729Medicaid
CT6809580-002OtherCIGNA
CTP2389276OtherOXFORD
CT022060OtherCONNECTICARE
CTP2389276OtherOXFORD