Healthcare Provider Details

I. General information

NPI: 1336121995
Provider Name (Legal Business Name): RICHARD ARDEN BRONEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE YALE PHYSICIANS BUILDING
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

PO BOX 9805 300 GEORGE ST 6TH FLOOR
NEW HAVEN CT
06536-0805
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2140
  • Fax: 203-785-6414
Mailing address:
  • Phone: 203-785-7998
  • Fax: 203-785-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number027238
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number027238
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: