Douglas L Idelson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

039521 Issued in CT

Practice address

55 Lock St
New Haven, CT 06511-3603

Phone

(203) 432-0206

Fax

(203) 432-0072

NPI assigned

Jun 23, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: didelson3456@direct.ynhh.org

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

• Yale University

  • Health Service Clinic/Center
  • New Haven, CT
  • NPI 1093862740
  Medicare reassignment NPD
• Yale University

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236

  Pediatrics

  Medicare reassignment NPD
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962
  NPD

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475539200000",
    "number": "1629004452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 LOCK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113603",
            "telephone_number": "203-432-0206",
            "fax_number": "203-432-0072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LOCK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113603",
            "telephone_number": "203-432-0206",
            "fax_number": "203-432-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDELSON",
        "first_name": "DOUGLAS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2016-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "039521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Giovanni Ibrahim, DMD
• Haitham Ibrahim Yakout Ibrahim, MD
• Ikeoluwapo Maymunah Ibrahim, MD
• Karim Ibrahim
• Ideal Home Health Care, LLC
• Daniel Iead, LCSW
• Ayomipo Ifidon, MD
• Seemal Iftikhar, MD
• Chinyere Julia Igboeli, CRNA
• Amina Igeh, MD

• Pediatrics Physician in New Haven, CT
• Providers in New Haven, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.