Basic Information
| Provider Information | |||||||||
| NPI: | 1942517404 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT RAPHAEL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 BARNETT ST | ||||||||
| Address2: | APT A1 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065152041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038044187 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1450 CHAPEL ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065114405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037893000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2010 | ||||||||
| LastUpdateDate: | 09/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | FOTJADHI | ||||||||
| AuthorizedOfficialFirstName: | SKERDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | RESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2037893000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.