Healthcare Provider Details

I. General information

NPI: 1669610168
Provider Name (Legal Business Name): LOHITH GOWDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LOHITH SHAKALADEVANAPURA BACHEGOWDA M.D.

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SMILOW CANCER CENTER, 35 PARK STREET
NEW HAVEN CT
06510
US

IV. Provider business mailing address

37 COLLEGE STREET DIVISION OF HEMATOLOGY YALE CANCER CENTER
NEW HAVEN CT
06511
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-4242
  • Fax:
Mailing address:
  • Phone: 203-785-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number56886
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number56886
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: