Individual
DR. MARK LEWIS WASSERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 COLUMBUS AVE, NEW HAVEN, CT 06519-1233
(203) 503-3250
(203) 503-3254
Mailing address
400 COLUMBUS AVE, NEW HAVEN, CT 06519-1233
(203) 503-3250
(203) 503-3254
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036223
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235900
—
CT
Enumeration date
06/22/2006
Last updated
12/16/2011
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