Individual
DR. PAUL ALLEN PUDIMAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
61 EMERALD GLEN RD, SALEM, CT 06420-4123
(860) 887-9053
(860) 887-9073
Mailing address
3998 FAIR RIDGE DRIVE, SUITE 300, FAIRFAX, VA 22033
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
037393
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001573935
—
CT
Enumeration date
01/05/2006
Last updated
03/13/2015
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