| Waterbury Neurology Llc | |
|
1625 Straits Turnpike Suite 307 Middlebury CT 06762-1836 | |
| (203) 758-8995 | |
| (203) 758-2571 |
| Full Name | Waterbury Neurology Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1625 Straits Turnpike, Middlebury, Connecticut |
| Authorized Official Name and Position | Pooia Fattahi (PARTNER) |
| Authorized Official Contact | 2037588995 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waterbury Neurology Llc 1625 Straits Turnpike Suite 307 Middlebury CT 06762-1836 Ph: (203) 758-8995 | Waterbury Neurology Llc 1625 Straits Turnpike Suite 307 Middlebury CT 06762-1836 Ph: (203) 758-8995 |
| NPI Number | 1255378501 |
|---|---|
| Provider Enumeration Date | 06/02/2006 |
| Last Update Date | 04/29/2016 |
| Medicare PECOS PAC ID | 0042247082 |
|---|---|
| Medicare Enrollment ID | O20050721000590 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255378501 | NPI | - | NPPES |
| 1284603 | Medicaid | CT | |
| 1361138 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (Connecticut) | Primary |
| Provider Name | David Tkeshelashvili |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306878731 PECOS PAC ID: 8527095488 Enrollment ID: I20050721000847 |
| Provider Name | Jianhui Zhang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1417170952 PECOS PAC ID: 1759431463 Enrollment ID: I20090617000667 |
| Provider Name | Pooia Fattahi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1669625174 PECOS PAC ID: 1850547795 Enrollment ID: I20120809000253 |
| Provider Name | Brian Koo |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1346435930 PECOS PAC ID: 3476625344 Enrollment ID: I20130909000069 |
| Provider Name | Sameer Ali |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1366777252 PECOS PAC ID: 6800020801 Enrollment ID: I20131007000410 |
| Provider Name | Gena Elizabeth Coelho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467882787 PECOS PAC ID: 8426280199 Enrollment ID: I20140410002173 |
| Provider Name | Katherine Kedzierski |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1548571110 PECOS PAC ID: 6204137672 Enrollment ID: I20151209002227 |
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