Healthcare Provider Details

I. General information

NPI: 1912024605
Provider Name (Legal Business Name): HOSPITAL OF ST. RAPHAEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
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

512 CHAPEL ST APT 1 F
NEW HAVEN CT
06511-6901
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3383
  • Fax:
Mailing address:
  • Phone: 516-551-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number001610
License Number StateCT

VIII. Authorized Official

Name: KEITH WILLIAMS
Title or Position: HEAD OF THE DEPARTMENT
Credential:
Phone: 203-789-3383