Basic Information
| Provider Information | |||||||||
| NPI: | 1821135187 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DOTTO | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 152 TEMPLE ST | ||||||||
| Address2: | APT. #304 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065102604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852788 | ||||||||
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| Practice Location | |||||||||
| Address1: | YALE NEW HAVEN HOSP - PATHOLOGY | ||||||||
| Address2: | 20 YORK STREET, CP2-631 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852788 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207ZP0007X | 230566 | MA | Y | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology |
No ID Information.