Healthcare Provider Details

I. General information

NPI: 1053739441
Provider Name (Legal Business Name): ANNA ELISABETH DENOBLE MD, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LONG WHARF DR
NEW HAVEN CT
06511-5991
US

IV. Provider business mailing address

1 LONG WHARF DR
NEW HAVEN CT
06511-5991
US

V. Phone/Fax

Practice location:
  • Phone: 413-686-0994
  • Fax:
Mailing address:
  • Phone: 413-686-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number201127
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: