Individual provider Active NPI

Evan Vosburgh, MD

  • Medical Oncology Physician
  • New Haven, CT
National Provider Identifier
1518955517
Registry record updated Jan 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
036782 Issued in CT
Practice address
800 Howard Ave
New Haven, CT 06519-1369
Phone
(203) 785-2140
NPI assigned
Oct 12, 2005
Last updated
Jan 15, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X 036782 CT Primary

Addresses

Primary practice location

800 Howard Ave
New Haven, CT 06519-1369

Mailing address

201 Tresser Blvd
Stamford, CT 06901-3435
Phone (203) 588-6664

Other identifiers 1

IdentifierTypeStateIssuer
001367821MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040513001297 CT Practitioner - Medical OncologyPractitioner - Hematology 8022008895 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036782CTMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cornell Scott Hill Health Corporation CurrentSince Nov 11, 2020 Accepting new patients

Locations

400 Columbus Ave
New Haven, CT 06519
Phone (203) 503-3174

428 Columbus Ave
New Haven, CT 06519
Phone (203) 503-3228

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358208000000",
    "number": "1518955517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 TRESSER BLVD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069013435",
            "telephone_number": "203-588-6664",
            "fax_number": "203-588-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 HOWARD AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191369",
            "telephone_number": "203-785-2140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VOSBURGH",
        "first_name": "EVAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2013-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "CT",
            "license": "036782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001367821",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.