Basic Information
| Provider Information | |||||||||
| NPI: | 1396922670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HITTELMAN | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | BENJAMIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 208058 | ||||||||
| Address2: | DEPARTMENT OF UROLOGY, YALE SCHOOL OF MEDICINE | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852815 | ||||||||
| FaxNumber: | 2037854043 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 CEDAR STREET, #208058 | ||||||||
| Address2: | DEPARTMENT OF UROLOGY, YALE SCHOOL OF MEDICINE | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852815 | ||||||||
| FaxNumber: | 2037854043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2008 | ||||||||
| LastUpdateDate: | 10/30/2012 | ||||||||
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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 | 208800000X | A82288 | CA | N | Allopathic & Osteopathic Physicians | Urology | 2088P0231X | A82288 | CA | Y | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
No ID Information.