Healthcare Provider Details

I. General information

NPI: 1619084365
Provider Name (Legal Business Name): UMA PADHYE PHATAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR STREET FMP 408
NEW HAVEN CT
06520
US

IV. Provider business mailing address

333 CEDAR STREET FMP 408
NEW HAVEN CT
06520
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4649
  • Fax: 203-737-1384
Mailing address:
  • Phone: 203-785-4649
  • Fax: 203-737-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number044227
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number044227
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: