Provider Demographics
NPI: | 1790719581 |
---|---|
Name: | HUMMEL, JAMES P (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JAMES |
Middle Name: | P |
Last Name: | HUMMEL |
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: | 34 KIMBERLY LN |
Mailing Address - Street 2: | |
Mailing Address - City: | MADISON |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06443-2079 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 789 HOWARD AVE |
Practice Address - Street 2: | |
Practice Address - City: | NEW HAVEN |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06519-1304 |
Practice Address - Country: | US |
Practice Address - Phone: | 203-737-4716 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-10 |
Last Update Date: | 2020-07-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 67693-20 | 207RC0000X |
WI | 67693 | 207RC0001X |
CT | 37848 | 207RC0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CT | 37848 | Other | CONNECTICUT MEDICAL LICENSE |
WI | 67693-20 | Other | WI LICENSE |