Organization
PRIME CARE MEDICAL GROUP P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIDYAPRIYA LOGANATHAN M.D. (MD)
(203) 753-8477
Entity
Organization
Contact information
Practice address
2457 E MAIN ST STE 1E, WATERBURY, CT 06705-2684
(203) 753-8477
Mailing address
2457 E MAIN ST STE 1E, WATERBURY, CT 06705-2684
(203) 753-8477
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG3286
RAIL ROAD MEDICARE
CT
Enumeration date
11/01/2006
Last updated
07/21/2022
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