MEDICARE: DR. JEFFREY T PRAVDA M.D.

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
1	207X00000X	Orthopaedic Surgery Physician	030667	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407879521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY T PRAVDA M.D.

Provider Business Mailing Address
First Line	:	863 N. MAIN ST. EXT.
Second Line	:	SUITE 200
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-1832
Country	:	US
Telephone Number	:	203-265-3280
Fax Number	:	203-741-6569

Provider Business Practice Location Address
First Line	:	863 N. MAIN ST. EXT.
Second Line	:	SUITE 200
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-1832
Country	:	US
Telephone Number	:	203-265-3280
Fax Number	:	203-741-6569

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/11/2011

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