| General Medical Practice Of West Haven Llc | |
|
309 Main St West Haven CT 06516-4424 | |
| (203) 933-4001 | |
| (203) 933-3759 |
| Full Name | General Medical Practice Of West Haven Llc |
|---|---|
| Speciality | General Practice |
| Location | 309 Main St, West Haven, Connecticut |
| Authorized Official Name and Position | Mallasetappa Shiranna Umapathy (PHYSICIAN/OWNER) |
| Authorized Official Contact | 2039334001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| General Medical Practice Of West Haven Llc 309 Main St West Haven CT 06516-4424 Ph: (203) 933-4001 | General Medical Practice Of West Haven Llc 309 Main St West Haven CT 06516-4424 Ph: (203) 933-4001 |
| NPI Number | 1285936559 |
|---|---|
| Provider Enumeration Date | 11/18/2010 |
| Last Update Date | 11/18/2010 |
| Medicare PECOS PAC ID | 0446448708 |
|---|---|
| Medicare Enrollment ID | O20101230000718 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285936559 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 025441 (Connecticut) | Primary |
| Provider Name | Mallasetappa S. Umapathy |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1811912512 PECOS PAC ID: 1254529514 Enrollment ID: I20101230000736 |
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