Healthcare Provider Details

I. General information

NPI: 1790719581
Provider Name (Legal Business Name): JAMES P HUMMEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 HOWARD AVE
NEW HAVEN CT
06519-1304
US

IV. Provider business mailing address

34 KIMBERLY LN
MADISON CT
06443-2079
US

V. Phone/Fax

Practice location:
  • Phone: 203-737-4716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number67693-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number67693
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number37848
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: