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Organization

WEST HAVEN MEDICAL GROUP, LLC

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. BENEDICT L FERNANDO M.D. (MANAGING PARTNER)
(203) 932-6481
Entity
Organization

Contact information

Practice address
687 CAMPBELL AVE, WEST HAVEN, CT 06516-3774
(203) 932-6481
(203) 932-4051
Mailing address
687 CAMPBELL AVE, WEST HAVEN, CT 06516-3774
(203) 932-6481
(203) 932-4051

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004250833
CT
Enumeration date
10/10/2008
Last updated
10/10/2008
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