Healthcare Provider Details

I. General information

NPI: 1568623791
Provider Name (Legal Business Name): OLOF VIKTORSDOTTIR MD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YUSM- DEPT OF ANESTHESIOLOGY 333 CEDAR ST-TMP 3
NEW HAVEN CT
06510
US

IV. Provider business mailing address

YUSM- DEPT OF ANESTHESIOLOGY 333 CEDAR ST-TMP 3
NEW HAVEN CT
06510
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2802
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-785-2802
  • Fax: 203-785-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL-233004
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number69118
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: