Basic Information
| Provider Information | |||||||||
| NPI: | 1841433364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALDASSARRI | ||||||||
| FirstName: | STEPHEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 CEDAR ST | ||||||||
| Address2: | TAC-441 SOUTH | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037853207 | ||||||||
| FaxNumber: | 2037853826 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 CEDAR ST | ||||||||
| Address2: | TAC-441 SOUTH | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037853207 | ||||||||
| FaxNumber: | 2037853826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2009 | ||||||||
| LastUpdateDate: | 04/21/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | 050681 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 050681 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 050681 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 050681 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.