Provider Demographics
NPI:1518176387
Name:GATES, ELISE KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:KATHLEEN
Last Name:GATES
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 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3650
Mailing Address - Country:US
Mailing Address - Phone:860-358-6000
Mailing Address - Fax:603-668-0164
Practice Address - Street 1:540 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4711
Practice Address - Country:US
Practice Address - Phone:860-358-2850
Practice Address - Fax:860-358-8698
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT052083208600000X, 2086X0206X
NH19124208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery