Provider Demographics
NPI:1124001342
Name:TAMBORLANE, WILLIAM V JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:V
Last Name:TAMBORLANE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHURCH ST S
Mailing Address - Street 2:SUITE 511
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1717
Mailing Address - Country:US
Mailing Address - Phone:203-764-9199
Mailing Address - Fax:203-764-9149
Practice Address - Street 1:2 CHURCH ST S
Practice Address - Street 2:SUITE 511
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1717
Practice Address - Country:US
Practice Address - Phone:203-764-9199
Practice Address - Fax:203-764-9149
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0174342080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001174341Medicaid
E30694Medicare UPIN
CT370000336Medicare ID - Type Unspecified