Organization
MD PHYSICAL THERAPY ASSOCIATES
Active
Parent organization
WEST HAVEN MEDICAL GROUP, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WEST HAVEN MEDICAL GROUP, LLC
Authorized official
DR. ANURUDDHA WALALIYADDA M.D. (MANAGING PARTNER)
(203) 932-6481
Entity
Organization
Contact information
Practice address
689 CAMPBELL AVE, WEST HAVEN, CT 06516-3711
(203) 932-6481
(203) 932-4051
Mailing address
689 CAMPBELL AVE, WEST HAVEN, CT 06516-3711
(203) 932-6481
(203) 932-4051
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
9446592000
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417955923
WEST HAVEN MEDICAL GROUP, LLC, NPI #
CT
Enumeration date
12/15/2009
Last updated
12/15/2009
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