Individual
DR. DEEPA CAMENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 688-5555
Mailing address
464 CONGRESS AVE STE 260, NEW HAVEN, CT 06519-1362
(203) 737-8310
(203) 785-3461
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
47964
CT
208000000X
Pediatrics Physician
47964
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004041000
APT FOUNDATION MEDICAID
CT
01
—
004217099
APT FOUNDATION MEDICAID
CT
01
—
008003745
APT FOUNDATION MEDICAID
CT
05
—
008040283
—
CT
Enumeration date
08/01/2006
Last updated
01/24/2022
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