Provider Demographics
NPI:1063491249
Name:UGURLU, MUSTAFA M (MD)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:M
Last Name:UGURLU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:538 LITCHFIELD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6669
Mailing Address - Country:US
Mailing Address - Phone:860-489-7017
Mailing Address - Fax:
Practice Address - Street 1:50 HOSPITAL HILL RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2096
Practice Address - Country:US
Practice Address - Phone:860-364-5411
Practice Address - Fax:860-364-5412
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN45887208600000X
CT44103208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN438942500Medicaid
MN438942500Medicaid
H89204Medicare UPIN
MN020001933Medicare ID - Type Unspecified