Provider Demographics
NPI:1710995204
Name:HOOD, DOUGLAS ROBERT (PA)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ROBERT
Last Name:HOOD
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:330 ORCHARD STREET
Mailing Address - Street 2:SUITE 216
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4430
Mailing Address - Country:US
Mailing Address - Phone:203-789-6047
Mailing Address - Fax:203-782-6311
Practice Address - Street 1:330 ORCHARD STREET
Practice Address - Street 2:SUITE 216
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4430
Practice Address - Country:US
Practice Address - Phone:203-789-6047
Practice Address - Fax:203-782-6311
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000270174400000X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No174400000XOther Service ProvidersSpecialist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970000256Medicare ID - Type Unspecified