Provider Demographics
NPI:1316474091
Name:ACKLEY, ELIZABETH HEARTT (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HEARTT
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:HEARTT
Other - Last Name:BAKACS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:866 QUINNIPIAC AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3329
Mailing Address - Country:US
Mailing Address - Phone:203-909-5821
Mailing Address - Fax:
Practice Address - Street 1:40 TEMPLE ST STE 7A
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2715
Practice Address - Country:US
Practice Address - Phone:203-789-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT68004207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty