Healthcare Provider Details

I. General information

NPI: 1538429014
Provider Name (Legal Business Name): PARIMAL DEODHAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST # T-209 YALE NEW HAVEN HOSPITAL
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

20 YORK ST # T-209 YALE NEW HAVEN HOSPITAL
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2259
  • Fax: 203-688-5599
Mailing address:
  • Phone: 203-688-2259
  • Fax: 203-688-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number054048
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: