Healthcare Provider Details

I. General information

NPI: 1235318478
Provider Name (Legal Business Name): CHRISTOPHER JOHN PITTENGER M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PARK ST 3RD FLOOR, CNRU
NEW HAVEN CT
06519-1109
US

IV. Provider business mailing address

34 PARK ST 3RD FLOOR, CNRU
NEW HAVEN CT
06519-1109
US

V. Phone/Fax

Practice location:
  • Phone: 203-974-7560
  • Fax: 203-974-7662
Mailing address:
  • Phone: 203-974-7560
  • Fax: 203-974-7662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number043577
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: