Healthcare Provider Details

I. General information

NPI: 1942543111
Provider Name (Legal Business Name): JEFFREY PAUL CRANFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LONG WHARF DR STE 302
NEW HAVEN CT
06511-5593
US

IV. Provider business mailing address

1 LONG WHARF DR STE 302
NEW HAVEN CT
06511-5593
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-7500
  • Fax:
Mailing address:
  • Phone: 203-777-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberFC4748945
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD.36891
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number62391
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: