Active NPI
Douglas Edwin Tichy, PA-C
- Physician Assistant
- New Haven, CT
National Provider Identifier
1104937994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001021
- Practice address
- 800 Howard Ave
Yale Physicians BLDG
New Haven, CT 06519-1369 - Phone
- (203) 785-2140
- Fax
- (203) 785-6414
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001021 | CT | Primary |
Addresses
Primary practice location
800 Howard Ave
Yale Physicians BLDG
New Haven, CT 06519-1369
Mailing address
PO Box 9805
300 George St 6TH FLR
New Haven, CT 06536-0805
Phone (203) 785-7998
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001021 | CT | MD | Physician Assistant |
Interoperability endpoints
- dtichy10127@direct.ynhh.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104937994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9805",
"address_2": "300 GEORGE ST 6TH FLR",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065360805",
"telephone_number": "203-785-7998",
"fax_number": "203-785-6414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 HOWARD AVE",
"address_2": "YALE PHYSICIANS BLDG",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065191369",
"telephone_number": "203-785-2140",
"fax_number": "203-785-6414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TICHY",
"first_name": "DOUGLAS",
"middle_name": "EDWIN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CT",
"license": "001021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.