Healthcare Provider Details

I. General information

NPI: 1477867331
Provider Name (Legal Business Name): PATRICK GEORGE CUDAHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CEDAR ST SUITE S169
NEW HAVEN CT
06519-1612
US

IV. Provider business mailing address

300 CEDAR ST SUITE S169
NEW HAVEN CT
06519-1612
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-7571
  • Fax:
Mailing address:
  • Phone: 203-785-7571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number52989
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: