Healthcare Provider Details

I. General information

NPI: 1669525473
Provider Name (Legal Business Name): DAVID STITELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR STREET YALE CHILDREN'S HOSPITAL
NEW HAVEN CT
06520
US

IV. Provider business mailing address

90 LINSLEY LAKE RD
NORTH BRANFORD CT
06471-1248
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-7643
  • Fax: 203-785-7643
Mailing address:
  • Phone: 203-481-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT184318
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number2086S0120X
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: