Gold Star Pediatrics LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

22070 Issued in CT

Legal business name

GOLD STAR PEDIATRICS LLC

Practice address

495 Gold Star Hwy
Ste 495
Groton, CT 06340-6228

Phone

(860) 449-8882

Fax

(860) 449-9195

NPI assigned

Jun 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael Blefeld

Title

Owner

Phone

(860) 449-8882

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230508800000",
    "number": "1033311915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 GOLD STAR HWY",
            "address_2": "STE 120",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406228",
            "telephone_number": "860-449-8882",
            "fax_number": "860-449-9195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 GOLD STAR HWY",
            "address_2": "STE 495",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406228",
            "telephone_number": "860-449-8882",
            "fax_number": "860-449-9195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLD STAR PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2008-12-29",
        "status": "A",
        "authorized_official_last_name": "BLEFELD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-449-8882",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "22070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004395530",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004238227",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany Adeline Goddiess, AU. D. CCC-A
• Mildred L Goebel
• Thomas Matthew Goebel, DMD
• Dennis Aurel Goguen, MSW, LCSW
• Michael Ray Goins, D.D.S.
• Steven David Goldberg, LMFT
• Galen Alexander Golden, DO
• Goldstar Family Dentistry
• Paul S. Goldstein, OTR/L
• Hector Salvador Gonzalez, IDC

• Pediatrics Physician in Groton, CT
• Providers in Groton, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.