Provider Demographics
NPI:1306164512
Name:ELMER L. VALIN, MD, LLC
Entity type:Organization
Organization Name:ELMER L. VALIN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:L
Authorized Official - Last Name:VALIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-867-5518
Mailing Address - Street 1:330 ORCHARD ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4417
Mailing Address - Country:US
Mailing Address - Phone:203-867-5508
Mailing Address - Fax:203-867-5509
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:SUITE 111
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-867-5508
Practice Address - Fax:203-867-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032798174400000X, 208600000X
CT003133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty