Provider Demographics
NPI:1881074482
Name:GILBERT, BENJAMIN T (PA-C)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:T
Last Name:GILBERT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 STRATFORD AVE
Mailing Address - Street 2:APARTMENT 511
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6344
Mailing Address - Country:US
Mailing Address - Phone:203-223-3511
Mailing Address - Fax:
Practice Address - Street 1:500 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4233
Practice Address - Country:US
Practice Address - Phone:203-223-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003341363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant