Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 60475 | CT |
NPI | 1184093163 |
---|---|
Provider Name | Dr. Vidya Puthenpura |
First Address | New Haven, CT 06510-3220 |
Second Address | New Haven, CT 06510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2015 |
Last Update Date | 18/05/2018 |