Provider Demographics
NPI:1679195275
Name:STOCKHAMMER, PAUL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:STOCKHAMMER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YORK STREET
Mailing Address - Street 2:YNHH TOMPKINS 226
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-9503
Mailing Address - Fax:203-688-5599
Practice Address - Street 1:20 YORK STREET
Practice Address - Street 2:YNHH TOMPKINS 226
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-9503
Practice Address - Fax:203-688-5599
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT75353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine