Healthcare Provider Details

I. General information

NPI: 1871527333
Provider Name (Legal Business Name): STEPHEN A. ATLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL STREET
NEW HAVEN CT
06511
US

IV. Provider business mailing address

1450 CHAPEL STREET
NEW HAVEN CT
06511
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-4044
  • Fax: 203-867-5534
Mailing address:
  • Phone: 203-789-3103
  • Fax: 203-789-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number021472
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: