Provider Demographics
NPI:1821088188
Name:VANDYCK, CHRISTOPHER H (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:H
Last Name:VANDYCK
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 1:1 CHURCH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3330
Mailing Address - Country:US
Mailing Address - Phone:203-764-8100
Mailing Address - Fax:203-764-8111
Practice Address - Street 1:1 CHURCH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3330
Practice Address - Country:US
Practice Address - Phone:203-764-8100
Practice Address - Fax:203-764-8111
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0274032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001274034Medicaid
E41917Medicare UPIN
CT260002041Medicare ID - Type Unspecified