Provider Demographics
NPI:1962681684
Name:FAMILY AND INTERNAL MEDICINE OF DIXWELL AVENUE
Entity Type:Organization
Organization Name:FAMILY AND INTERNAL MEDICINE OF DIXWELL AVENUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BABU
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-230-4160
Mailing Address - Street 1:2543 DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1809
Mailing Address - Country:US
Mailing Address - Phone:203-230-4160
Mailing Address - Fax:203-230-4169
Practice Address - Street 1:2543 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1809
Practice Address - Country:US
Practice Address - Phone:203-230-4160
Practice Address - Fax:203-230-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF62278Medicare UPIN