Provider Demographics
NPI:1669437851
Name:MCCULLOUGH, DAVID HURD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HURD
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-385-1166
Mailing Address - Fax:203-381-0608
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-385-1166
Practice Address - Fax:203-381-0608
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT035958207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001359589Medicaid
CT001359589Medicaid
CTD400133987Medicare PIN
CTE94672Medicare UPIN