Healthcare Provider Details

I. General information

NPI: 1952340887
Provider Name (Legal Business Name): MOHAN VODAPALLY M.D.,DABPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2447 WHITNEY AVE, SUITE 1
HAMDEN CT
06511-3211
US

IV. Provider business mailing address

2447 WHITNEY AVE, SUITE1
HAMDEN CT
06518-3211
US

V. Phone/Fax

Practice location:
  • Phone: 203-624-4400
  • Fax: 203-624-4402
Mailing address:
  • Phone: 203-624-4400
  • Fax: 203-624-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number039595
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number039595
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: