Provider Demographics
NPI:1477572303
Name:THANGADA, VENUGOPAL (MD,)
Entity Type:Individual
Prefix:DR
First Name:VENUGOPAL
Middle Name:
Last Name:THANGADA
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 1:28 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2834
Mailing Address - Country:US
Mailing Address - Phone:860-652-8155
Mailing Address - Fax:860-774-0826
Practice Address - Street 1:1007 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-0839
Practice Address - Country:US
Practice Address - Phone:860-774-2020
Practice Address - Fax:860-774-0826
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0322462084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0013153056Medicaid
CTF87097Medicare UPIN
CT0013153056Medicaid