=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275444671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONNECTICUT WEIGHT LOSS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2026
-----------------------------------------------------
Last Update Date | 09/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 POST RD E # 6
-----------------------------------------------------
City | WESTPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06880-5605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-852-4921
-----------------------------------------------------
Fax | 203-413-5760
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1701 POST RD E
-----------------------------------------------------
City | WESTPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06880-5605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-852-4921
-----------------------------------------------------
Fax | 203-413-5760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. KUMUDA KUMAR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 646-852-4921
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0000X
-----------------------------------------------------
Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------