Provider Demographics
NPI:1356483382
Name:VANDEUSEN, TIMOTHY CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:VANDEUSEN
Suffix:
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 1:270 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4400
Mailing Address - Country:US
Mailing Address - Phone:203-974-5907
Mailing Address - Fax:203-974-5905
Practice Address - Street 1:270 CENTER ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4400
Practice Address - Country:US
Practice Address - Phone:203-974-5907
Practice Address - Fax:203-974-5905
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA482072084P0804X
CT490102084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF69750Medicare UPIN