Individual
RAMACHANDRA ILLINDALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 GRAND ST, NEW BRITAIN, CT 06052-2016
(860) 224-5661
(860) 224-5785
Mailing address
100 GRAND ST, NEW BRITAIN, CT 06052-2016
(860) 224-5661
(860) 224-5785
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
042577
CT
208M00000X
Hospitalist Physician
Primary
042577
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001425778
—
CT
Enumeration date
06/01/2005
Last updated
05/25/2012
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