Active NPI
Liesel L. Gould, M.D.
- Pediatric Adolescent Medicine Physician
- North Haven, CT
National Provider Identifier
1720048150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- 035385
- Practice address
- 451 State St
North Haven, CT 06473-3019 - Phone
- (203) 248-8888
- Fax
- (203) 248-8889
- NPI assigned
- Mar 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | 035385 | CT | Primary |
Addresses
Primary practice location
451 State St
North Haven, CT 06473-3019
Mailing address
451 State St
North Haven, CT 06473-3019
Phone (203) 248-8888
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P652646 | Other | CT | OXFORD |
| 035383 | Other | CT | CONNECTICARE |
| 001353838 | Medicaid | CT | |
| OQ1356 | Other | CT | HEALTHNET |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 035385 | CT | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Complete Pediatrics | Adolescent Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Adolescent Medicine Physician
- North Haven, CT
- NPI 1871731927
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323302400000",
"number": "1720048150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "451 STATE ST",
"city": "NORTH HAVEN",
"state": "CT",
"postal_code": "064733019",
"telephone_number": "203-248-8888",
"fax_number": "203-248-8889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 STATE ST",
"city": "NORTH HAVEN",
"state": "CT",
"postal_code": "064733019",
"telephone_number": "203-248-8888",
"fax_number": "203-248-8889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOULD",
"first_name": "LIESEL",
"middle_name": "L.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-28",
"last_updated": "2011-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "CT",
"license": "035385",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P652646",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE",
"identifier": "035383",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001353838",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "OQ1356",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.