Healthcare Provider Details

I. General information

NPI: 1124511753
Provider Name (Legal Business Name): NATHANIEL PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST # CB-2041 YALE NEW HAVEN HOSPITAL / NORTHEAST MEDICAL GROUP
NEW HAVEN CT
06510
US

IV. Provider business mailing address

20 YORK ST
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-4748
  • Fax:
Mailing address:
  • Phone: 203-688-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number69153
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: