Provider Demographics
NPI:1760778344
Name:GAMBLE, MIRIAM JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:JOY
Last Name:GAMBLE
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 1:464 CONGRESS AVE
Mailing Address - Street 2:RM 266
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1361
Mailing Address - Country:US
Mailing Address - Phone:203-737-3326
Mailing Address - Fax:203-737-5187
Practice Address - Street 1:464 CONGRESS AVE
Practice Address - Street 2:RM 266
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1361
Practice Address - Country:US
Practice Address - Phone:203-737-3326
Practice Address - Fax:203-737-5187
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN16314390200000X
CT53057207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program