Basic Information
| Provider Information | |||||||||
| NPI: | 1386634764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLEDGE | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 LIBERTY ST | ||||||||
| Address2: | YALE PSYCHIATRIC HOSPITAL, LV-113 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036882619 | ||||||||
| FaxNumber: | 2037372221 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 LIBERTY ST | ||||||||
| Address2: | YALE PSYCHIATRIC HOSPITAL, LV-113 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036882619 | ||||||||
| FaxNumber: | 2037372221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 04/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 015736 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 001157361 | 05 | CT | MEDICAID |