Individual provider Active NPI

Kara Gormley, DMD

  • Dentist
  • New Haven, CT
National Provider Identifier
1639473952
Registry record updated Dec 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
010103 Issued in CT
Practice address
111 Park St Ste 1B
New Haven, CT 06511-5472
Phone
(203) 562-5101
NPI assigned
Dec 29, 2010
Last updated
Dec 29, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 010103 CT Primary

Addresses

Primary practice location

111 Park St Ste 1B
New Haven, CT 06511-5472

Mailing address

111 Park St Ste 1B
New Haven, CT 06511-5472

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160614002057 CT Order and Referring Only - DentistPractitioner - Dentist 3173814647

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
010103CTMDDentist
10103CTMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1293580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293580800000",
    "number": "1639473952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 PARK ST STE 1B",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 PARK ST STE 1B",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115472",
            "telephone_number": "203-562-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMLEY",
        "first_name": "KARA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-29",
        "last_updated": "2010-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "010103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.