Healthcare Provider Details

I. General information

NPI: 1295039675
Provider Name (Legal Business Name): YALE HEMOPHILIA TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR STREET DEPARTMENT OF PEDIATRICS , 2073 LMP
NEW HAVEN CT
06520-8064
US

IV. Provider business mailing address

333 CEDAR STREET DEPARTMENT OF PEDIATRICS, 2073 LMP
NEW HAVEN CT
06520-8064
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4640
  • Fax: 203-785-5315
Mailing address:
  • Phone: 203-785-4640
  • Fax: 203-785-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number045596
License Number StateCT

VIII. Authorized Official

Name: PATRICK GALLAGHER
Title or Position: DIRECTOR
Credential: M.D.
Phone: 203-688-2320