Healthcare Provider Details

I. General information

NPI: 1487674768
Provider Name (Legal Business Name): PETER SCHULAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST, NP-4 SMILOW CANCER CENTER - YNHH
NEW HAVEN CT
06510-3202
US

IV. Provider business mailing address

P.O. BOX 208041, FMP 316 YALE SCHOOL OF MEDICINE, DEPT OF UROLOGY
NEW HAVEN CT
06520-8041
US

V. Phone/Fax

Practice location:
  • Phone: 203-200-4822
  • Fax: 203-200-2099
Mailing address:
  • Phone: 203-785-2815
  • Fax: 203-785-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA71468
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number50525
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: