Healthcare Provider Details

I. General information

NPI: 1497812911
Provider Name (Legal Business Name): URSULA MCMILLIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ORCHARD ST SUITE 111
NEW HAVEN CT
06511-4417
US

IV. Provider business mailing address

330 ORCHARD ST SUITE 111
NEW HAVEN CT
06511-4417
US

V. Phone/Fax

Practice location:
  • Phone: 203-867-5508
  • Fax: 203-867-5509
Mailing address:
  • Phone: 203-867-5508
  • Fax: 203-867-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number048483
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: