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General NPI Number Information
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NPI Number | 1649387770
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Entity Type | Individual
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Provider Name | HOWARD LEE DISTELMAN MD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 515 BOSTON ST
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City | GUILFORD
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State | CT
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Zip | 06437-2960
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Country | US
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Telephone | 203-453-3100
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Fax | 203-458-9456
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Provider Business Mailing Address
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Address Line | 515 BOSTON ST
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City | GUILFORD
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State | CT
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Zip | 06437-2960
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Country | US
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Telephone | 203-453-3100
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Fax | 203-458-9456
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 028769
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License Number State | CT
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