Provider Demographics
NPI:1578561551
Name:GLADSTEIN, GINA (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:GLADSTEIN
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 1:4 DEARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5351
Mailing Address - Country:US
Mailing Address - Phone:203-869-3082
Mailing Address - Fax:203-869-6453
Practice Address - Street 1:4 DEARFIELD DR
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5351
Practice Address - Country:US
Practice Address - Phone:203-869-3082
Practice Address - Fax:203-869-6453
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029885207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010029885CT01OtherANTHEM BCBS
14F461OtherEMPIRE
029885OtherCONNECTICARE
566645OtherAETNA
2V8861OtherHEALTHNET
010029885CT01OtherANTHEM BCBS
14F461OtherEMPIRE
2V8861OtherHEALTHNET