Provider Demographics
NPI:1497768006
Name:DUMITRESCU, MIRELA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRELA
Middle Name:
Last Name:DUMITRESCU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3463
Mailing Address - Country:US
Mailing Address - Phone:203-371-5873
Mailing Address - Fax:203-371-5874
Practice Address - Street 1:5520 PARK AVE
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3463
Practice Address - Country:US
Practice Address - Phone:203-371-5873
Practice Address - Fax:203-371-5874
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040456207RR0500X
CT40456207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH73453Medicare UPIN
CT110008821Medicare ID - Type Unspecified