Basic Information
| Provider Information | |||||||||
| NPI: | 1396726113 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HURWITZ | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 CEDAR ST | ||||||||
| Address2: | YALE UNIVERSITY SCHOOL OF MEDICINE | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032004822 | ||||||||
| FaxNumber: | 2032002099 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 CEDAR ST | ||||||||
| Address2: | YALE UNIVERSITY SCHOOL OF MEDICINE | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032004822 | ||||||||
| FaxNumber: | 2032002099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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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 | 207RX0202X | 048823 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2037921 | 05 | MA | MEDICAID | J27195 | 01 | MA | BCBS MA | OTHER | 469044 | 01 | MA | TUFTS HEALTH PLAN | OTHER |