Healthcare Provider Details

I. General information

NPI: 1962715169
Provider Name (Legal Business Name): KATHARINE TUMAMPOS DECENA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 NEW LONDON TPKE
NORWICH CT
06360-2624
US

IV. Provider business mailing address

164 OTROBANDO AVE
NORWICH CT
06360-2116
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-4600
  • Fax: 860-889-5200
Mailing address:
  • Phone: 860-886-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number55689
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: