Provider Demographics
NPI:1023127271
Name:PETERSEN-CRAIR, PAMELA JEAN (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:PETERSEN-CRAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:293-785-2618
Mailing Address - Fax:203-737-2221
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:CB2039
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:293-785-2618
Practice Address - Fax:203-737-2221
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK78642084P0800X
CT0447462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH66164Medicare UPIN
TX8G3393Medicare ID - Type Unspecified