Healthcare Provider Details

I. General information

NPI: 1366882409
Provider Name (Legal Business Name): NATHAN RHYS GWILLIAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 WHITNEY AVE WHITNEY OFFICE SUITES #2
NEW HAVEN CT
06511
US

IV. Provider business mailing address

389 WHITNEY AVE WHITNEY OFFICE SUITES #2
NEW HAVEN CT
06511
US

V. Phone/Fax

Practice location:
  • Phone: 203-293-6258
  • Fax:
Mailing address:
  • Phone: 203-293-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number71782
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: