Healthcare Provider Details

I. General information

NPI: 1376583591
Provider Name (Legal Business Name): RICHARD ALLEN ROSENCRANTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06504-8900
US

IV. Provider business mailing address

333 CEDAR ST; FMP 408 PO BOX 208064
NEW HAVEN CT
06520-8064
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4649
  • Fax: 203-737-1384
Mailing address:
  • Phone: 203-785-4649
  • Fax: 203-737-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number046998
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: