Provider Demographics
NPI:1154450450
Name:TESLUK, CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:TESLUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 BRADLEY ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1103
Mailing Address - Country:US
Mailing Address - Phone:203-562-4942
Mailing Address - Fax:203-773-1271
Practice Address - Street 1:240 BRADLEY ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1103
Practice Address - Country:US
Practice Address - Phone:203-562-4942
Practice Address - Fax:203-773-1271
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT248692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE31728Medicare UPIN
CT260002266Medicare ID - Type Unspecified