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NPI Code Detail

MEDICARE: NATALIE POONAM DEQUILLFELDT MD, MA

MEDICARE: NATALIE POONAM DEQUILLFELDT MD, MA
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
1207R00000XInternal Medicine PhysicianDR.0073199CO
2390200000XStudent in an Organized Health Care Education/Training Program80967CT

General Provider Information

NPI Number : 1710568258
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATALIE POONAM DEQUILLFELDT MD, MA
Provider Business Mailing Address
First Line : 20 YORK ST
Second Line :
City : NEW HAVEN
State : CT
Zip : 06510-3220
Country : US
Telephone Number : 203-688-4242
Fax Number :
Provider Business Practice Location Address
First Line : 777 BANNOCK ST
Second Line :
City : DENVER
State : CO
Zip : 80204-4597
Country : US
Telephone Number : 303-436-4949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2021
Last Update Date : 04/22/2026

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