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Individual

TAGELDIN BANAGA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1333 E MAIN ST APT 5, BRIDGEPORT, CT 06608-1400
(203) 543-3819
Mailing address
1333 E MAIN ST APT 5, BRIDGEPORT, CT 06608-1400
(203) 543-3819

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
017671860
CT

Other

Enumeration date
09/08/2018
Last updated
09/08/2018
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