Basic Information
| Provider Information | |||||||||
| NPI: | 1346457215 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ARLEN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 789 HOWARD AVENUE FMP 302 | ||||||||
| Address2: | YALE MEDICINE DEPARTMENT OF UROLOGY | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854755 | ||||||||
| FaxNumber: | 2037854043 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 YORK STREET | ||||||||
| Address2: | YALE NEW HAVEN HOSPITAL | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854755 | ||||||||
| FaxNumber: | 2037854043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 02/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | R7864 | IA | N | Allopathic & Osteopathic Physicians | Urology | 2088P0231X | 67530 | GA | N | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | 2088P0231X | MD-41930 | IA | N | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | 2088P0231X | 56048 | CT | Y | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
ID Information
| ID | Type | State | Issuer | Description | 003131425A | 05 | GA | MEDICAID |