Healthcare Provider Details

I. General information

NPI: 1396712311
Provider Name (Legal Business Name): CHARLES STEWART FUCHS MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST YALE MEDICAL SCHOOL
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST WWW205
NEW HAVEN CT
06520
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4672
  • Fax:
Mailing address:
  • Phone: 203-785-4371
  • Fax: 203-785-4116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number60552
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number56014
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number60552
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number56014
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: