MEDICARE: DR. VASUDHA VALLABHANENI 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	207R00000X	Internal Medicine Physician	036272	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	:	1568421352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VASUDHA VALLABHANENI M.D.

Provider Business Mailing Address
First Line	:	3180 MAIN ST
Second Line	:	SUITE 301
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-4237
Country	:	US
Telephone Number	:	203-373-9100
Fax Number	:	203-365-8492

Provider Business Practice Location Address
First Line	:	3180 MAIN ST
Second Line	:	SUITE 301
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-4237
Country	:	US
Telephone Number	:	203-373-9100
Fax Number	:	203-365-8492

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	05/31/2013

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