Provider Demographics
NPI:1245472604
Name:CONNECTICUT REGIONAL PAIN SPECIALISTS,LLC
Entity type:Organization
Organization Name:CONNECTICUT REGIONAL PAIN SPECIALISTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/PRACTICE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:SADA
Authorized Official - Last Name:VODAPALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-624-4400
Mailing Address - Street 1:2447 WHITNEY AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3211
Mailing Address - Country:US
Mailing Address - Phone:203-624-4400
Mailing Address - Fax:203-624-4402
Practice Address - Street 1:2447 WHITNEY AVE STE 2B
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3211
Practice Address - Country:US
Practice Address - Phone:203-624-4400
Practice Address - Fax:203-624-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH40494Medicare UPIN