Healthcare Provider Details

I. General information

NPI: 1003808353
Provider Name (Legal Business Name): ARTHUR H KNOWLTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

PO BOX 8416
NEW HAVEN CT
06530-0416
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3131
  • Fax: 203-789-3133
Mailing address:
  • Phone: 203-777-6209
  • Fax: 203-787-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number014766
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: