Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT186318 | PA |
N | 111NI0900X | Internist | MT186318 | PA |
N | 208000000X | Pediatrician | MT186318 | PA |
Y | 2080P0202X | Pediatric Cardiologist | 52090 | CT |
NPI | 1154525244 |
---|---|
Provider Name | Robert W Elder JR. |
First Address | New Haven, CT 06510-3206 |
Second Address | New Haven, CT 06510-3206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 10/06/2013 |