Individual
JOHN C SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 CEDAR STREET LMP4085, DEPARTMENT OF PEDIATRICS, NEW HAVEN, CT 06520-8064
(203) 785-6668
(203) 785-6925
Mailing address
333 CEDAR STREET-LMP4085, P.O.BOX 208064 DEPARTMENT OF PEDIATRICS, NEW HAVEN, CT 06520-8064
(203) 785-6668
(203) 785-6925
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
047046
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00575388
—
NY
Enumeration date
09/07/2006
Last updated
05/11/2010
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