Provider Demographics
NPI:1447244645
Name:ARBULU, ALFREDO A (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:A
Last Name:ARBULU
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 1:15 PALOMBA DR
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3853
Mailing Address - Country:US
Mailing Address - Phone:860-253-5586
Mailing Address - Fax:860-253-6271
Practice Address - Street 1:15 PALOMBA DR
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3888
Practice Address - Country:US
Practice Address - Phone:860-253-5586
Practice Address - Fax:860-253-6271
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018047170100000X
CT000018047208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010018047-CT01OtherBCBS
CT00118047000OtherBLUE CARE FAMILY PLAN
CT070083OtherCONNECTICARE
CT4260627OtherAETNA
CT61373363OtherUNITED HEALTH CARE
CTP489093OtherOXFORD HEALTH PLANS
CT0240898-003OtherCIGNA
CT1180470Medicaid
CT0R3608OtherHEALTH NET
CT020000421Medicare ID - Type Unspecified
CT4260627OtherAETNA