Basic Information
| Provider Information | |||||||||
| NPI: | 1487674768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHULAM | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 208041, FMP 316 | ||||||||
| Address2: | YALE SCHOOL OF MEDICINE, DEPT OF UROLOGY | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852815 | ||||||||
| FaxNumber: | 2037854043 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 YORK ST, NP-4 | ||||||||
| Address2: | SMILOW CANCER CENTER - YNHH | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032004822 | ||||||||
| FaxNumber: | 2032002099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 08/14/2012 | ||||||||
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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 | 208800000X | A71468 | CA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 50525 | CT | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 00A714680 | 05 | CA | MEDICAID |