Healthcare Provider Details

I. General information

NPI: 1205100559
Provider Name (Legal Business Name): KABUL S. GARG MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 GEORGE ST
NEW HAVEN CT
06511-5322
US

IV. Provider business mailing address

666 GEORGE ST
NEW HAVEN CT
06511-5322
US

V. Phone/Fax

Practice location:
  • Phone: 203-624-7635
  • Fax: 203-624-5662
Mailing address:
  • Phone: 203-624-7635
  • Fax: 203-624-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number022368
License Number StateCT

VIII. Authorized Official

Name: KABUL S GARG
Title or Position: OWNER
Credential: MD
Phone: 203-624-7635