Healthcare Provider Details

I. General information

NPI: 1124066576
Provider Name (Legal Business Name): MEVELYN MICHELLE MORSE DPM. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 HEMINGWAY AVE
EAST HAVEN CT
06512-2384
US

IV. Provider business mailing address

365 HEMINGWAY AVE
EAST HAVEN CT
06512-2384
US

V. Phone/Fax

Practice location:
  • Phone: 203-466-1410
  • Fax: 203-466-6410
Mailing address:
  • Phone: 203-466-1410
  • Fax: 203-466-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000802
License Number StateCT

VIII. Authorized Official

Name: DR. MEVELYN MICHELLE MORSE
Title or Position: OWNER
Credential: DPM
Phone: 203-466-1410