Basic Information
| Provider Information | |||||||||
| NPI: | 1154525244 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ELDER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 CEDAR ST | ||||||||
| Address2: | YALE UNIVERSITY, PEDIATRIC CARDIOLOGY, PO BOX 208064 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103206 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 CEDAR ST | ||||||||
| Address2: | YALE UNIVERSITY, PEDIATRIC CARDIOLOGY | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852022 | ||||||||
| FaxNumber: | 2037372786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 06/10/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT186318 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | MT186318 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | 52090 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
No ID Information.