Provider Demographics
NPI:1376671396
Name:KARELLAS, MICHAEL EMMANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EMMANUEL
Last Name:KARELLAS
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 1:800 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1369
Mailing Address - Country:US
Mailing Address - Phone:203-737-6959
Mailing Address - Fax:203-785-4043
Practice Address - Street 1:800 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-737-6959
Practice Address - Fax:203-785-4043
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 241182208800000X
NJ25MA08557100208800000X
CT055043208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0199770Medicaid
NJP00944510OtherRR MCR PTAN
NJP00944510OtherRR MCR PTAN