Provider Demographics
NPI:1033329768
Name:PRAKASH HUDED & SUMANGALA HUDED PTR
Entity Type:Organization
Organization Name:PRAKASH HUDED & SUMANGALA HUDED PTR
Other - Org Name:DRS/ PRAKASH & SUE HUDED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMANGALA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-342-4800
Mailing Address - Street 1:78 MARLBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-4801
Mailing Address - Country:US
Mailing Address - Phone:860-342-4800
Mailing Address - Fax:860-342-3298
Practice Address - Street 1:78 MARLBOROUGH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-4801
Practice Address - Country:US
Practice Address - Phone:860-342-4800
Practice Address - Fax:860-342-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC14749OtherMEDICARE RAILROAD
CTC01239Medicare UPIN
CTC01239Medicare PIN