Provider Demographics
NPI:1659015170
Name:PERUMANGOTE VASUDEVAN, AKHILA ARYA (MD)
Entity Type:Individual
Prefix:MRS
First Name:AKHILA ARYA
Middle Name:
Last Name:PERUMANGOTE VASUDEVAN
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 1:267 GRANT STREET YALE NEW HAVEN HEALTH/BRIDGEPORT HOSPI
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610
Mailing Address - Country:US
Mailing Address - Phone:203-384-3883
Mailing Address - Fax:
Practice Address - Street 1:267 GRANT STREET YALE NEW HAVEN HEALTH/BRIDGEPORT HOSPI
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610
Practice Address - Country:US
Practice Address - Phone:203-384-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program