Healthcare Provider Details

I. General information

NPI: 1497790026
Provider Name (Legal Business Name): RALPH WAYNE DENATALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 STATE ST
NORTH HAVEN CT
06473-2132
US

IV. Provider business mailing address

280 STATE ST
NORTH HAVEN CT
06473-2132
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-2886
  • Fax: 203-288-2576
Mailing address:
  • Phone: 203-288-2886
  • Fax: 203-288-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number027199
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number027199
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: