Individual
IRVIN M MODLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
789 HOWARD AVE, FITKIN BUILDING - 2ND FLOOR, NEW HAVEN, CT 06519-1304
(203) 785-3207
(203) 785-3826
Mailing address
789 HOWARD AVE, FITKIN BUILDING - 2ND FLOOR, NEW HAVEN, CT 06519-1304
(203) 785-3207
(203) 785-3826
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
025885
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001258854
—
CT
Enumeration date
12/15/2005
Last updated
03/16/2011
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