Healthcare Provider Details

I. General information

NPI: 1588062541
Provider Name (Legal Business Name): SUSAN T. SAVULAK, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 LIBERTY ST UNIT 111
SOUTHINGTON CT
06489-3114
US

IV. Provider business mailing address

31 LIBERTY ST UNIT 111
SOUTHINGTON CT
06489-3114
US

V. Phone/Fax

Practice location:
  • Phone: 860-276-0191
  • Fax: 860-276-0195
Mailing address:
  • Phone: 860-276-0191
  • Fax: 860-276-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number035159
License Number StateCT

VIII. Authorized Official

Name: DR. SUSAN T SAVULAK
Title or Position: MEMBER
Credential: M.D.
Phone: 860-276-0191