Provider Demographics
NPI:1326175886
Name:RHEUMATOLOGY ASSOCIATES OF NEW HAVEN
Entity Type:Organization
Organization Name:RHEUMATOLOGY ASSOCIATES OF NEW HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-785-0885
Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-785-0885
Mailing Address - Fax:203-624-9714
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-785-0885
Practice Address - Fax:203-624-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004135069Medicaid
CT004135069Medicaid
CTB84579Medicare UPIN
CTF63749Medicare UPIN
CT004135069Medicaid