MEDICARE: MALLASETAPPA SHIRANNA UMAPATHY 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	208D00000X	General Practice Physician	025441	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	:	1811912512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLASETAPPA SHIRANNA UMAPATHY MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	06/06/2013

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