Provider Demographics
NPI:1992784268
Name:GOSTKOWSKI, TIMOTHY PETER (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PETER
Last Name:GOSTKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 LITCHFIELD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6669
Mailing Address - Country:US
Mailing Address - Phone:860-489-7017
Mailing Address - Fax:860-489-8943
Practice Address - Street 1:538 LITCHFIELD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6669
Practice Address - Country:US
Practice Address - Phone:860-489-7017
Practice Address - Fax:860-489-8943
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT33160208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001331602-01OtherBLUECARE FAMILY PLAN (MCD
033160OtherCONNECTICARE
P667456OtherOXFORD
0846181OtherCIGNA
3487070OtherAETNA
2V4881OtherHEALTHNET
CO010033160CT03OtherANTHEM BC/BS
CO010033160CT03OtherANTHEM BC/BS