West Haven Medical Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

016636 Issued in CT

Legal business name

WEST HAVEN MEDICAL GROUP, LLC

Practice address

687 Campbell Ave
West Haven, CT 06516-3774

Phone

(203) 932-6481

Fax

(203) 932-4051

NPI assigned

Jul 8, 2005

Last updated

Jan 21, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Anuruddha Walaliyadda, M.D.

Title

Managing Partner

Phone

(203) 932-6481

Specialties & licenses 2

Addresses

Locations

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• MD Physical Therapy Associates

  • Physical Medicine & Rehabilitation Physician
  • West Haven, CT
  • NPI 1538498902
  NPPES parent name
• West Haven Medical Group, LLC

  • Nurse Practitioner
  • West Haven, CT
  • NPI 1669623484
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390262400000",
    "number": "1417955923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "687 CAMPBELL AVE",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065163774",
            "telephone_number": "203-932-6481",
            "fax_number": "203-932-4051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "687 CAMPBELL AVE",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065163774",
            "telephone_number": "203-932-6481",
            "fax_number": "203-932-4051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST HAVEN MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2014-01-21",
        "status": "A",
        "authorized_official_last_name": "WALALIYADDA",
        "authorized_official_first_name": "ANURUDDHA",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "203-932-6481",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CT",
            "license": "016797",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "016636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Wesolowicz, PHD
• West Haven Board of Education
• West Haven Center for Nursing & Rehabilitation, LLC
• West Haven Dental LLC
• West Haven Markets Inc (ShopRite Pharmacy of West Haven)
• West Haven Medical Group, LLC
• West Haven Pediatrics, LLC
• West Haven Pediatrics, LLC
• West Haven Pharmacy, LLC (West Haven Pharmacy)
• West Haven Pharmacy, LLC

• Internal Medicine Physician in West Haven, CT
• Providers in West Haven, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.