Healthcare Provider Details

I. General information

NPI: 1033329768
Provider Name (Legal Business Name): PRAKASH HUDED & SUMANGALA HUDED PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 MARLBOROUGH ST
PORTLAND CT
06480-4801
US

IV. Provider business mailing address

78 MARLBOROUGH ST
PORTLAND CT
06480-4801
US

V. Phone/Fax

Practice location:
  • Phone: 860-342-4800
  • Fax: 860-342-3298
Mailing address:
  • Phone: 860-342-4800
  • Fax: 860-342-3298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUMANGALA HUDED
Title or Position: PHYSICIAN/PARTNER
Credential: M.D.
Phone: 860-342-4800