Paul Allen Pudimat, M.D.
Individual provider Active NPI Anesthesiology Physician · Salem, CT
NPI 1669450102 · NPPES record last updated Mar 13, 2015
Key facts
- NPI
- 1669450102
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 037393 (CT)
- Practice address
- 61 Emerald Glen Rd
Salem, CT 06420-4123 - Phone
- (860) 887-9053
- Fax
- (860) 887-9073
- NPI assigned
- Jan 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100923001165 | CT | Practitioner - Anesthesiology | 0648179796 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 037393 | CT | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North American Partners in Anesthesia Connecticut PC | Anesthesiology | Current |
Accepting new patients |
| Windham Community Memorial Hospital, Inc. | Current |
Accepting new patients | |
| William W Backus Hospital | Current |
Accepting new patients | |
| Integrated Anesthesia Associates LLC | Anesthesiology | Current |
Accepting new patients |
| The William W Backus Hospital | Current | Accepting new patients | |
| Connecticut Gi PLLC | Current |
Accepting new patients | |
| Norwich Anesthesia Associates, PC | Anesthesiology | Past |
Accepting new patients |
Locations
80 Seymour St
Hartford, CT 06106
Phone (860) 545-2249
85 Seymour St
Ste 1000
Hartford, CT 06106
Phone (860) 246-2571
100 Grand St
New Britain, CT 06052
Phone (860) 224-5011
326 Washington St
Norwich, CT 06360
Phone (860) 701-0140
30 Waterchase Dr
Rocky Hill, CT 06067
Phone (860) 257-4131
112 Mansfield Ave
Willimantic, CT 06226
Phone (830) 423-6410
68 S Service Rd
Ste 350
Melville, NY 11747
Phone (516) 945-3107
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 037393 | CT | Yes |
Addresses
Primary practice location
61 Emerald Glen Rd
Salem, CT 06420-4123
Mailing address
3998 Fair Ridge Drive, Suite 300
Fairfax, VA 22033
Phone (703) 295-9360
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001573935 | Medicaid | CT |
Other providers in Salem, CT
- Kylie Elizabeth Mikulka
- Nasilele Musutu
- New Beginnings for Life, LLC
- Physiocare Physical Therapy and Sports Medicine, LLC
- Mary Ann S Pudimat
- Joan D Rankowitz
- Nancy Rodgers
- Roseann Z George
- Erin Russo
- Salem Pharmacy LLC
All providers in Salem, CT · Anesthesiology Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.