Individual
SUPHICHAYA MUANGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1625 STRAITS TPKE, SUITE 209, MIDDLEBURY, CT 06762-1836
(203) 758-9100
(203) 758-9400
Mailing address
1625 STRAITS TPKE, SUITE 209, MIDDLEBURY, CT 06762-1836
(203) 758-9100
(203) 758-9400
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
043440
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001153600
—
CT
05
—
001434406
—
CT
01
—
010043440CT02
ANTHEM BCBS CT
CT
01
—
043440
CONNECTICARE
CT
01
—
1105253
USA
CT
01
—
25-33213
AMERICHOICE
CT
01
—
3V0829
HEALTHNET/COMMERCIAL
CT
01
—
518685
WELLCARE
CT
01
—
7085716
AETNA
CT
01
—
P00796456
RR MEDICARE
CT
01
—
P3941581
OXFORD
CT
Enumeration date
12/05/2006
Last updated
07/15/2014
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