Individual
DR. SRINIVASULU CONJEEVARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 LINWOOD AVE STE 2A, COLCHESTER, CT 06415-1138
(860) 415-3622
(860) 974-0884
Mailing address
11 WINTHROP RD, APT 2A, WEST HARTFORD, CT 06110-1656
(860) 415-3622
(860) 540-1226
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
53644
CT
207R00000X
Internal Medicine Physician
53644
CT
208D00000X
General Practice Physician
4301086842
MI
208D00000X
General Practice Physician
53644
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053644
STATE MEDICAL LICENSE
CT
Enumeration date
03/02/2012
Last updated
03/24/2023
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