Provider Demographics
NPI:1699764480
Name:KRUMHOLZ, HARLAN M (MD)
Entity type:Individual
Prefix:
First Name:HARLAN
Middle Name:M
Last Name:KRUMHOLZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 CHURCH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3330
Mailing Address - Country:US
Mailing Address - Phone:203-785-7998
Mailing Address - Fax:203-785-6414
Practice Address - Street 1:333 CEDAR ST
Practice Address - Street 2:I456 SHM
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:203-764-5885
Practice Address - Fax:203-764-5653
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2009-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT032590207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001325902Medicaid
E30298Medicare UPIN
CT001325902Medicaid