Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 017434 | CT |
NPI | 1124001342 |
---|---|
Provider Name | William V Tamborlane JR. |
First Address | New Haven, CT 06519-1717 |
Second Address | New Haven, CT 06519-1717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 06/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001174341 | (05) | CT |
E30694 | (02) |