Provider Demographics
NPI:1386000941
Name:PRIMARY CARE AND WALK IN LLC
Entity Type:Organization
Organization Name:PRIMARY CARE AND WALK IN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SREEDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTIPARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-891-7134
Mailing Address - Street 1:1423 CHAPEL ST
Mailing Address - Street 2:SUITE 1 B
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4411
Mailing Address - Country:US
Mailing Address - Phone:203-891-7134
Mailing Address - Fax:203-891-7765
Practice Address - Street 1:1423 CHAPEL ST
Practice Address - Street 2:1 B
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4411
Practice Address - Country:US
Practice Address - Phone:203-891-7134
Practice Address - Fax:203-891-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty