Healthcare Provider Details

I. General information

NPI: 1558377739
Provider Name (Legal Business Name): MICHAEL HARVEY PAULIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 CHAPEL ST
NEW HAVEN CT
06511
US

IV. Provider business mailing address

69 OAK ST
WATERTOWN CT
06795
US

V. Phone/Fax

Practice location:
  • Phone: 203-865-3852
  • Fax: 203-865-2983
Mailing address:
  • Phone: 860-945-1369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number003418
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: