Healthcare Provider Details

I. General information

NPI: 1699049478
Provider Name (Legal Business Name): NADA DERAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST # I-308
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST # I-308
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-5408
  • Fax: 414-266-1616
Mailing address:
  • Phone: 203-785-5408
  • Fax: 414-266-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number72495
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number72495
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: