Healthcare Provider Details

I. General information

NPI: 1558715466
Provider Name (Legal Business Name): PATIENT CHOICE MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2016
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 WHITNEY AVE SUITE 250
HAMDEN CT
06518-3600
US

IV. Provider business mailing address

PO BOX 636
GUILFORD CT
06437-0636
US

V. Phone/Fax

Practice location:
  • Phone: 203-535-0262
  • Fax: 203-535-0374
Mailing address:
  • Phone: 203-535-0262
  • Fax: 203-535-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number06556
License Number StateCT

VIII. Authorized Official

Name: GARAMUNI ANURA DESILVA
Title or Position: OWNER
Credential: MD
Phone: 203-535-0262