NPIMap

Organization Active NPI

East Haddam Medical Associate,PC

  • Physician Assistant
  • Moodus, CT
National Provider Identifier
1063472363
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
000457 Issued in CT
Legal business name
EAST HADDAM MEDICAL ASSOCIATE,PC
Practice address
16 William F Palmer Rd
Moodus, CT 06469-1131
Phone
(860) 873-1414
Fax
(860) 873-3428
NPI assigned
Mar 23, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Ms. Pamela Gourlie
Title
Office Manager
Phone
(860) 873-8983

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 024845 CT
Physician Assistant 363A00000X 000457 CT Primary

Addresses

Primary practice location

16 William F Palmer Rd
Moodus, CT 06469-1131

Mailing address

16 William F Palmer Rd
P O Box 430
Moodus, CT 06469-1131
Phone (860) 873-1414

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1063472363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 WILLIAM F PALMER RD",
            "address_2": "P O BOX 430",
            "city": "MOODUS",
            "state": "CT",
            "postal_code": "064691131",
            "telephone_number": "860-873-1414",
            "fax_number": "860-873-3428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 WILLIAM F PALMER RD",
            "city": "MOODUS",
            "state": "CT",
            "postal_code": "064691131",
            "telephone_number": "860-873-1414",
            "fax_number": "860-873-3428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST HADDAM MEDICAL ASSOCIATE,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "GOURLIE",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "860-873-8983",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "024845",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "000457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moodus, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.