Provider Demographics
NPI:1558715466
Name:PATIENT CHOICE MEDICAL CARE LLC
Entity Type:Organization
Organization Name:PATIENT CHOICE MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARAMUNI
Authorized Official - Middle Name:ANURA
Authorized Official - Last Name:DESILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-535-0262
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
Practice Address - Street 2:SUITE 250
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3600
Practice Address - Country:US
Practice Address - Phone:203-535-0262
Practice Address - Fax:203-535-0374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-17
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 363LA2200X
CT06556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty