Provider Demographics
NPI:1942517404
Name:SAINT RAPHAEL HOSPITAL
Entity Type:Organization
Organization Name:SAINT RAPHAEL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SKERDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FOTJADHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-789-3000
Mailing Address - Street 1:26 BARNETT ST
Mailing Address - Street 2:APT A1
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2041
Mailing Address - Country:US
Mailing Address - Phone:203-804-4187
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-06
Last Update Date:2010-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital