Provider Demographics
NPI:1669491775
Name:DODDAMANE, SANTOSH (DO)
Entity Type:Individual
Prefix:
First Name:SANTOSH
Middle Name:
Last Name:DODDAMANE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 BARNES ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-284-3159
Mailing Address - Fax:203-284-3150
Practice Address - Street 1:97 BARNES ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-284-3144
Practice Address - Fax:203-284-3140
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT043771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H75839Medicare UPIN