Healthcare Provider Details

I. General information

NPI: 1588578801
Provider Name (Legal Business Name): INFECTIOUS DISEASES & TRAVEL MEDICINE CENTER OF WALLINGFORD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N MAIN STREET EXT BUILDING 2, UNIT 1B
WALLINGFORD CT
06492-2400
US

IV. Provider business mailing address

850 N MAIN STREET EXT BUILDING 2, UNIT 1B
WALLINGFORD CT
06492-2400
US

V. Phone/Fax

Practice location:
  • Phone: 617-653-9938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. OGHENERUONA ODILI
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 203-701-1567