Provider Demographics
NPI:1093741019
Name:DEVITO, RALPH J (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:J
Last Name:DEVITO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:330 ORCHARD ST
Mailing Address - Street 2:SUITE 164
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4417
Mailing Address - Country:US
Mailing Address - Phone:203-789-2222
Mailing Address - Fax:203-624-3697
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:SUITE 164
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-789-2222
Practice Address - Fax:203-624-3697
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT019370208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT340000109Medicare ID - Type UnspecifiedMEDICARE NUMBER
CTB83920Medicare UPIN