Provider Demographics
NPI:1801970900
Name:MOECKEL, GILBERT WOLFRAM (MD, PHD)
Entity type:Individual
Prefix:PROF
First Name:GILBERT
Middle Name:WOLFRAM
Last Name:MOECKEL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208023
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8023
Mailing Address - Country:US
Mailing Address - Phone:203-737-2803
Mailing Address - Fax:203-785-3348
Practice Address - Street 1:310 CEDAR ST # LB20
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3218
Practice Address - Country:US
Practice Address - Phone:203-737-2803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD16417207ZP0102X
TNMD34491207ZP0102X
CT46205207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H23756Medicare UPIN