Provider Demographics
NPI:1225126014
Name:PRALEA, CATALIN (MD)
Entity Type:Individual
Prefix:
First Name:CATALIN
Middle Name:
Last Name:PRALEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 SILVER STREET, P.O. BOX 351
Mailing Address - Street 2:LEAK HALL/RVS
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-262-5200
Mailing Address - Fax:860-262-5316
Practice Address - Street 1:399 SILVER STREET,
Practice Address - Street 2:LEAK HALL/RVS
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-262-5200
Practice Address - Fax:860-262-5316
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0403642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4014679Medicaid
1403641OtherCLINIC
CT4024972Medicaid
CT260004410Medicare ID - Type UnspecifiedFIRST COAST
CT4024972Medicaid
CT4014679Medicaid