Healthcare Provider Details

I. General information

NPI: 1174501175
Provider Name (Legal Business Name): DURGADAS P SAKALKALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WHITNEY AVE SUITE 170
HAMDEN CT
06518-3691
US

IV. Provider business mailing address

2408 WHITNEY AVE
HAMDEN CT
06518-3209
US

V. Phone/Fax

Practice location:
  • Phone: 203-752-3100
  • Fax: 203-752-9291
Mailing address:
  • Phone: 203-752-3100
  • Fax: 203-752-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number43012
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number43012
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number43012
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: