Provider Demographics
NPI:1487674768
Name:SCHULAM, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:SCHULAM
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:P.O. BOX 208041, FMP 316
Mailing Address - Street 2:YALE SCHOOL OF MEDICINE, DEPT OF UROLOGY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8041
Mailing Address - Country:US
Mailing Address - Phone:203-785-2815
Mailing Address - Fax:203-785-4043
Practice Address - Street 1:20 YORK ST, NP-4
Practice Address - Street 2:SMILOW CANCER CENTER - YNHH
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3202
Practice Address - Country:US
Practice Address - Phone:203-200-4822
Practice Address - Fax:203-200-2099
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71468208800000X
CT50525208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A714680Medicaid
CA00A714680Medicaid
CAG63179Medicare UPIN