Healthcare Provider Details

I. General information

NPI: 1033613955
Provider Name (Legal Business Name): NNAMDI DANIEL UDEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 06/24/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

20 YORK ST
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2433
  • Fax: 203-688-9258
Mailing address:
  • Phone: 203-688-2433
  • Fax: 203-688-9258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number74579
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: