Basic Information
| Provider Information | |||||||||
| NPI: | 1295039675 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YALE HEMOPHILIA TREATMENT CENTER | ||||||||
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| OtherOrganizationName: | YALE UNIVERSITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 CEDAR STREET | ||||||||
| Address2: | DEPARTMENT OF PEDIATRICS, 2073 LMP | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854640 | ||||||||
| FaxNumber: | 2037855315 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 CEDAR STREET | ||||||||
| Address2: | DEPARTMENT OF PEDIATRICS , 2073 LMP | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854640 | ||||||||
| FaxNumber: | 2037855315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2010 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | GALLAGHER | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2036882320 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | 045596 | CT | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
No ID Information.