Healthcare Provider Details

I. General information

NPI: 1134133697
Provider Name (Legal Business Name): CRAIG R. HUTTLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 CHAPEL STREET
NEW HAVEN CT
06511
US

IV. Provider business mailing address

1435 CHAPEL STREET
NEW HAVEN CT
06511
US

V. Phone/Fax

Practice location:
  • Phone: 203-562-6741
  • Fax: 203-562-2533
Mailing address:
  • Phone: 203-562-6741
  • Fax: 203-562-6741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number028352
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: