Provider Demographics
NPI:1952330540
Name:GABRIELE, KATHLEEN (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:GABRIELE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WOODLAND ST
Mailing Address - Street 2:SUITE 31
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2372
Mailing Address - Country:US
Mailing Address - Phone:860-522-7984
Mailing Address - Fax:860-724-5224
Practice Address - Street 1:19 WOODLAND ST
Practice Address - Street 2:SUITE 31
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2372
Practice Address - Country:US
Practice Address - Phone:860-522-7984
Practice Address - Fax:860-724-5224
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043918207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1952330540Medicaid
CT1952330540Medicaid