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NPI Code Detail

MEDICARE: GENERAL MEDICAL PRACTICE OF WEST HAVEN LLC

MEDICARE: GENERAL MEDICAL PRACTICE OF WEST HAVEN LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician025441CT

General Provider Information

NPI Number : 1285936559
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENERAL MEDICAL PRACTICE OF WEST HAVEN LLC
Provider Business Mailing Address
First Line : 309 MAIN ST
Second Line :
City : WEST HAVEN
State : CT
Zip : 06516-4424
Country : US
Telephone Number : 203-933-4001
Fax Number : 203-933-3759
Provider Business Practice Location Address
First Line : 309 MAIN ST
Second Line :
City : WEST HAVEN
State : CT
Zip : 06516-4424
Country : US
Telephone Number : 203-933-4001
Fax Number : 203-933-3759
Authorized Official
Title or Position : PHYSICIAN/OWNER
Name : DR. MALLASETAPPA SHIRANNA UMAPATHY
Credential : M.D.
Telephone Number : 203-933-4001
Provider Enumeration Date : 11/18/2010
Last Update Date : 11/18/2010

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Directions to “GENERAL MEDICAL PRACTICE OF WEST HAVEN LLC ” Practice Location

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