Healthcare Provider Details

I. General information

NPI: 1629005582
Provider Name (Legal Business Name): STEN H VERMUND MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 COLLEGE ST RM 431
NEW HAVEN CT
06510-3201
US

IV. Provider business mailing address

60 COLLEGE ST RM 431
NEW HAVEN CT
06510-3201
US

V. Phone/Fax

Practice location:
  • Phone: 615-720-3677
  • Fax: 203-785-6103
Mailing address:
  • Phone: 615-720-3677
  • Fax: 203-785-6103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number137172
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number137172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: