Healthcare Provider Details

I. General information

NPI: 1972602209
Provider Name (Legal Business Name): SUSAN DEBORAH KRUGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE VA CONNECTICUT HEALTHCARE SYSTEM (WEST HAVEN) - 116A
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

24 WALDEN ST
HAMDEN CT
06517-2535
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax: 203-937-4789
Mailing address:
  • Phone: 203-288-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number030062
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: