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General NPI Number Information
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NPI Number | 1962922401
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Entity Type | Individual
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Provider Name | UTTARA KOUL MD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 2660 MAIN ST STE 216
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City | BRIDGEPORT
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State | CT
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Zip | 06606-5301
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Country | US
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Telephone | 203-332-1949
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Fax |
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Provider Business Mailing Address
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Address Line | 2660 MAIN ST STE 216
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City | BRIDGEPORT
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State | CT
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Zip | 06606-5301
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Country | US
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Telephone | 203-332-1949
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number | 036157164
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 72454
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number | 72454
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License Number State | CT
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