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General NPI Number Information
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NPI Number | 1053394064
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Entity Type | Individual
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Provider Name | MARK P HOMMEL MD
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 20 YORK ST YNHH (CHILDREN'S) ER DEPARMENT
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City | NEW HAVEN
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State | CT
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Zip | 06510-3220
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Country | US
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Telephone | 203-688-7970
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Fax | 203-688-4809
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Provider Business Mailing Address
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Address Line | PO BOX 9805 300 GEORGE ST 6TH FLOOR
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City | NEW HAVEN
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State | CT
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Zip | 06536-0805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 035303
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License Number State | CT
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