Provider Demographics
NPI:1902846082
Name:GILDERSLEEVE, KRISTIN S (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:S
Last Name:GILDERSLEEVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 LIBERTY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-1553
Mailing Address - Country:US
Mailing Address - Phone:860-228-1119
Mailing Address - Fax:
Practice Address - Street 1:23 LIBERTY DR
Practice Address - Street 2:SUITE A
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248-1553
Practice Address - Country:US
Practice Address - Phone:860-228-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001382374Medicaid
CTG39995Medicare UPIN
CT080001529Medicare ID - Type Unspecified