Healthcare Provider Details

I. General information

NPI: 1760063994
Provider Name (Legal Business Name): MA SU SU AUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE STE 2112
HARTFORD CT
06105-1719
US

IV. Provider business mailing address

1000 ASYLUM AVE STE 2112
HARTFORD CT
06105-1719
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-3711
  • Fax:
Mailing address:
  • Phone: 860-522-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number84911
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: