Provider Demographics
NPI:1295039675
Name:YALE HEMOPHILIA TREATMENT CENTER
Entity Type:Organization
Organization Name:YALE HEMOPHILIA TREATMENT CENTER
Other - Org Name:YALE UNIVERSITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-688-2320
Mailing Address - Street 1:333 CEDAR STREET
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS, 2073 LMP
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8064
Mailing Address - Country:US
Mailing Address - Phone:203-785-4640
Mailing Address - Fax:203-785-5315
Practice Address - Street 1:333 CEDAR STREET
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS , 2073 LMP
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8064
Practice Address - Country:US
Practice Address - Phone:203-785-4640
Practice Address - Fax:203-785-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0455962080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty