MEDICARE: MIHAELA OLIVIA NEGULESCU MD

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	207RN0300X	Nephrology Physician	038999	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	038999	OTHER	CT	LICENSE
2	2V6467	OTHER		HEALTHNET
3	010038999CT02	OTHER		ANTHEM BCBS

General Provider Information

NPI Number	:	1558473801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIHAELA OLIVIA NEGULESCU MD

Provider Business Mailing Address
First Line	:	88 NORWICH NEW LONDON TPKE
Second Line	:
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-2518
Country	:	US
Telephone Number	:	860-367-0087
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 NORWICH NEW LONDON TPKE
Second Line	:
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-2518
Country	:	US
Telephone Number	:	860-367-0087
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/23/2012

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