Healthcare Provider Details

I. General information

NPI: 1154525244
Provider Name (Legal Business Name): ROBERT W ELDER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST YALE UNIVERSITY, PEDIATRIC CARDIOLOGY
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST YALE UNIVERSITY, PEDIATRIC CARDIOLOGY, PO BOX 208064
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2022
  • Fax: 203-737-2786
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT186318
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT186318
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number52090
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: