Provider Demographics
NPI:1841420726
Name:OLDHAM, MARK ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:OLDHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:FITKIN 615
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:203-785-2618
Mailing Address - Fax:203-737-2221
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:FITKIN 615
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-785-2618
Practice Address - Fax:203-737-2221
Is Sole Proprietor?:No
Enumeration Date:2009-07-25
Last Update Date:2023-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAAH 1918018-52442084P0800X
NY2914842084P0800X
CT0516812084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry