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Individual

KALYAN K PUNDLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
100 HAZARD AVE STE 101, ENFIELD, CT 06082-5447
(860) 696-2380
Mailing address
1290 SILAS DEANE HWY, HHC CVO ENROLLMENT 1ST FLOOR, WETHERSFIELD, CT 06109-4337
(860) 972-6970

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
258256
MA
207R00000X
Internal Medicine Physician
Primary
65199
CT
208M00000X
Hospitalist Physician
258256
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
65199
CT LIC
CT
Enumeration date
04/23/2011
Last updated
06/18/2020
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