Healthcare Provider Details

I. General information

NPI: 1992292791
Provider Name (Legal Business Name): SUSEL OROPESA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 OLD DIXWELL AVE
HAMDEN CT
06518-3144
US

IV. Provider business mailing address

20 SALEM RD
WOODBRIDGE CT
06525-2624
US

V. Phone/Fax

Practice location:
  • Phone: 203-248-6365
  • Fax:
Mailing address:
  • Phone: 305-282-1154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number69904
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: