Healthcare Provider Details

I. General information

NPI: 1013238559
Provider Name (Legal Business Name): UMU KULTUMI BAH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MOUNT PLEASANT RD
NEWTOWN CT
06470
US

IV. Provider business mailing address

7 ACADIA LN PH 6404
SHELTON CT
06484-4466
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-1818
  • Fax:
Mailing address:
  • Phone: 240-888-3694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number017215
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0004200
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4226
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: