Healthcare Provider Details

I. General information

NPI: 1528636529
Provider Name (Legal Business Name): NELSON UGWU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TEMPLE ST STE 5A
NEW HAVEN CT
06510-2745
US

IV. Provider business mailing address

40 TEMPLE ST STE 5A
NEW HAVEN CT
06510-2745
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-3466
  • Fax:
Mailing address:
  • Phone: 203-785-3466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number81233
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: