Provider Demographics
NPI:1275539892
Name:DESILVA, GARUMUNI A (MD)
Entity Type:Individual
Prefix:
First Name:GARUMUNI
Middle Name:A
Last Name:DESILVA
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:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-0636
Mailing Address - Country:US
Mailing Address - Phone:203-535-0262
Mailing Address - Fax:203-535-0374
Practice Address - Street 1:2080 WHITNEY AVE STE 250
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3606
Practice Address - Country:US
Practice Address - Phone:203-535-0262
Practice Address - Fax:203-535-0374
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001431569Medicaid
CT3803706OtherAETNA
CT010043156CT01OtherANTHEM
CT2V7218OtherHEALTHNET
CTP00225805OtherMEDICARE RAILROAD
CT001431569Medicaid
CTP3619235OtherUNITED HEALTHCARE/OXFORD
CT010043156CT01OtherANTHEM
CT043156OtherCONNECTICARE