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General NPI Number Information
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NPI Number | 1750475117
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Entity Type | Individual
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Provider Name | MARGARET KIYO IKEDA M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 374 GRAND AVE
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City | NEW HAVEN
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State | CT
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Zip | 06513-3733
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Country | US
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Telephone | 203-777-7411
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Fax | 203-777-6508
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Provider Business Mailing Address
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Address Line | 11 FLYING POINT RD
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City | BRANFORD
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State | CT
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Zip | 06405-5703
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Country | US
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Telephone | 203-488-2296
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | 028111
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 028111
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License Number State | CT
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