Provider Demographics
NPI:1396208419
Name:KAUFMAN, ODELYA HARTUNG (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ODELYA
Middle Name:HARTUNG
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:ODELYA
Other - Middle Name:
Other - Last Name:HARTUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 LONG WHARF DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5991
Mailing Address - Country:US
Mailing Address - Phone:203-785-2660
Mailing Address - Fax:203-785-3404
Practice Address - Street 1:1 LONG WHARF DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5991
Practice Address - Country:US
Practice Address - Phone:203-785-2660
Practice Address - Fax:203-785-3404
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT75435207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)