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General NPI Number Information
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NPI Number | 1083916910
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Entity Type | Organization
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Legal Business Name | DAVID H. MCCULLOUGH, M.D. & ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 33 KING ST
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City | STRATFORD
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State | CT
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Zip | 06615-5849
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Country | US
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Telephone | 203-385-1166
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Fax | 203-381-0608
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Provider Business Mailing Address
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Address Line | 33 KING ST
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City | STRATFORD
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State | CT
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Zip | 06615-5849
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Country | US
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Telephone | 203-385-1166
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Fax | 203-381-0608
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Authorized Official
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Title or Position | SOLE MEMBER LLC
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Name | DR. DAVID HURD MCCULLOUGH
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Credential | M.D.
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Telephone | 203-385-1166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 035958
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License Number State | CT
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