Healthcare Provider Details

I. General information

NPI: 1982711586
Provider Name (Legal Business Name): DAVID L TINKLEPAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PERKINS FARM DR
MYSTIC CT
06355-4037
US

IV. Provider business mailing address

100 PERKINS FARM DR
MYSTIC CT
06355-4037
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-1433
  • Fax:
Mailing address:
  • Phone: 860-886-1433
  • Fax: 860-886-4644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number039506
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number039506
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: