Provider Demographics
NPI:1083916910
Name:DAVID H. MCCULLOUGH, M.D. & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DAVID H. MCCULLOUGH, M.D. & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HURD
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-385-1166
Mailing Address - Street 1:33 KING ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5849
Mailing Address - Country:US
Mailing Address - Phone:203-385-1166
Mailing Address - Fax:203-381-0608
Practice Address - Street 1:33 KING ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5849
Practice Address - Country:US
Practice Address - Phone:203-385-1166
Practice Address - Fax:203-381-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035958207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001359589Medicaid
CTE94672Medicare UPIN