Provider Demographics
NPI:1730121377
Name:SENA, KANAGA (MD)
Entity Type:Individual
Prefix:
First Name:KANAGA
Middle Name:
Last Name:SENA
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 1:24 LONGMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-2537
Mailing Address - Country:US
Mailing Address - Phone:203-261-0410
Mailing Address - Fax:
Practice Address - Street 1:2590 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5838
Practice Address - Country:US
Practice Address - Phone:203-377-5988
Practice Address - Fax:203-380-0531
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0164152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001164151Medicaid
CTC65005Medicare UPIN
CT130000060Medicare ID - Type UnspecifiedMEDICARE ID#