Provider Demographics
NPI:1790981611
Name:GFELLER, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:GFELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-2508
Mailing Address - Country:US
Mailing Address - Phone:860-808-8720
Mailing Address - Fax:860-808-1540
Practice Address - Street 1:500 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2508
Practice Address - Country:US
Practice Address - Phone:860-808-8720
Practice Address - Fax:860-808-1540
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011956207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008010702Medicaid
D80779Medicare UPIN
CT008010702Medicaid