Healthcare Provider Details

I. General information

NPI: 1053526954
Provider Name (Legal Business Name): CHRISTOPHER BRUCE RANSOM MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST LCI 712
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

230 HEPBURN RD
HAMDEN CT
06517-2928
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4085
  • Fax:
Mailing address:
  • Phone: 203-288-1904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberAPPLIED FOR
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: