Individual ProviderMaryam GondalInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address330 Cedar Street, Bb 114, New Haven, CT 06510(203) 785-4184PECOS EnrollmentBased on the most recent information from CMS, provider Maryam Gondal is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:14 PM.Profile DetailsProvider ID1003163593Provider TypeIndividualFull NameGondal, MaryamTitleMs.CredentialM.D.GenderFemaleSole ProprietorYesEnumeration Date8/14/2012Last Updated8/10/2022Contact InformationPractice LocationPractice Address330 Cedar Street, Bb 114, New Haven, CT 06510Phone(203) 785-4184FaxUnlisted FaxMailing LocationMailing Address330 Cedar Street, Bb 114, New Haven, CT 06510Phone(203) 785-4184Fax(203) 785-7068Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense71978ConnecticutCode207RN0300XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense40627South Carolina