Individual
FAFA HUBERTA KOUDORO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1260 SILAS DEANE HWY STE 104, WETHERSFIELD, CT 06109-4363
(860) 289-3375
Mailing address
100 HAZARD AVE STE 100, ENFIELD, CT 06082-5447
(860) 289-3375
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
72410
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/01/2017
Last updated
04/24/2026
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