Provider Demographics
NPI:1538132246
Name:GILES, SUSAN STOCKER (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:STOCKER
Last Name:GILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:DIANE
Other - Last Name:STOCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:515 MIDDLE TPKE W
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3816
Mailing Address - Country:US
Mailing Address - Phone:860-432-8400
Mailing Address - Fax:860-432-8430
Practice Address - Street 1:1000 ASYLUM AVE STE 2115
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1719
Practice Address - Country:US
Practice Address - Phone:860-714-4000
Practice Address - Fax:860-714-8612
Is Sole Proprietor?:No
Enumeration Date:2006-02-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031879207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001318791Medicaid