Basic Information
| Provider Information | |||||||||
| NPI: | 1902974694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EMMANOUEL | ||||||||
| FirstName: | MARKOS | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037814740 | ||||||||
| FaxNumber: | 2037814751 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037814740 | ||||||||
| FaxNumber: | 2037814751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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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 | 2084P0800X | EC-06-1051 | ME | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.