Healthcare Provider Details

I. General information

NPI: 1457619751
Provider Name (Legal Business Name): ANDREW PHILIP NOTARIANNI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST., TOMPKINS 3 YUSM DEPARTMENT OF ANESTHESIOLOGY
NEW HAVEN CT
06520
US

IV. Provider business mailing address

333 CEDAR ST., TMP 3 YALE UNIVERSITY DEPARTMENT OF ANESTHESIOLOGY
NEW HAVEN CT
06510
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number61885
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number17074
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: