Healthcare Provider Details

I. General information

NPI: 1154709061
Provider Name (Legal Business Name): BRADLEY WILLIAM KAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK STREET YALE NEW HAVEN HOSPITAL, DEPARTMENT OF CARDIOLOGY
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

175 SHERMAN AVE
NEW HAVEN CT
06511-4357
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-4242
  • Fax:
Mailing address:
  • Phone: 203-789-3363
  • Fax: 203-789-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301106991
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number73967
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: