Individual
PATTI MUGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4 SHAWS CV STE 103, NEW LONDON, CT 06320-4956
(860) 443-3778
Mailing address
1290 SILAS DEANE HWY FL 1, WETHERSFIELD, CT 06109-4337
(860) 972-6970
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
066927
CT
207Q00000X
Family Medicine Physician
51076
AZ
390200000X
Student in an Organized Health Care Education/Training Program
29375
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
066927
CT LICENSE
CT
05
—
067083
—
AZ
Enumeration date
07/06/2012
Last updated
12/07/2020
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