Individual
EZRA M DETROY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 785-2385
Mailing address
589 CHAPEL ST # 2, NEW HAVEN, CT 06511-6919
(203) 984-1420
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
54063
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2010
Last updated
04/27/2015
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