Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 47964 | CT |
N | 208000000X | Pediatrician | 47964 | CT |
NPI | 1952318214 |
---|---|
Provider Name | Dr. Deepa Camenga |
First Address | New Haven, CT 06519-1362 |
Second Address | New Haven, CT 06510-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 24/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004041000 | APT FOUNDATION MEDICAID (01) | CT |
004217099 | APT FOUNDATION MEDICAID (01) | CT |
008003745 | APT FOUNDATION MEDICAID (01) | CT |
008040283 | (05) | CT |