Provider Demographics
NPI:1992796387
Name:SHLOMCHIK, MARK J (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:SHLOMCHIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:YNHH, CLINIC BUILDING, ROOM 407
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-785-2153
Mailing Address - Fax:203-737-5554
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YNHH, CLINIC BUILDING, ROOM 407
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-2153
Practice Address - Fax:203-737-5554
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT032870207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001328708Medicaid
CT220000449Medicare ID - Type Unspecified
CT001328708Medicaid