Healthcare Provider Details

I. General information

NPI: 1790783702
Provider Name (Legal Business Name): ELAINE YORDAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE SUITE 1026
HARTFORD CT
06105-1770
US

IV. Provider business mailing address

1000 ASYLUM AVE SUITE 2109A
HARTFORD CT
06105-1770
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4355
  • Fax: 860-714-8054
Mailing address:
  • Phone: 860-714-6581
  • Fax: 860-714-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number022728
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22728
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: