Healthcare Provider Details

I. General information

NPI: 1396754479
Provider Name (Legal Business Name): THEODORE ZANKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WHITNEY AVE
NEW HAVEN CT
06511-3715
US

IV. Provider business mailing address

315 WHITNEY AVE
NEW HAVEN CT
06511-3715
US

V. Phone/Fax

Practice location:
  • Phone: 203-562-9444
  • Fax: 203-562-2360
Mailing address:
  • Phone: 203-562-9444
  • Fax: 203-562-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number13142
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: