| Doctor Name: | DR. GORDON E FOSDICK |
| NPI Number: | 1740206192 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 00723 |
| Business Practice Address: | 470 Main St Middlefield, CT - 064551210 |
| Business Phone Number: | 8603498500 |
| Business Fax Number: | 8603493081 |
| Mailing Address: | 196 Parkway S, Suite 304 WATERFORD |
| State: | CT |
| Postal Code: | 063851234 |
| Phone Number: | 8604427027 |
| Fax Number: | 8604440074 |
| NPI Enumeration Date: | 07/15/2006 |
| NPI Last Update Date: | 06/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | 00723 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |