Alfred A Caudullo, D.O.
Individual provider Active NPI Emergency Medicine Physician · Vernon, CT
NPI 1942276118 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1942276118
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- CT 000530 (CT)
- Practice address
- 31 Union St
Vernon, CT 06066-3126 - Phone
- (860) 872-5291
- NPI assigned
- Feb 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
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 |
|---|---|---|---|---|
| I20070129000219 | CT | Practitioner - Emergency Medicine | 0345241741 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CT 000530 | CT | MD | Emergency Medicine Physician |
| 530 | CT | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The William W Backus Hospital | Current |
Accepting new patients | |
| William W Backus Hospital | Current |
Accepting new patients |
Locations
326 Washington St
Norwich, CT 06360
Phone (860) 701-0140
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | CT 000530 | CT | Yes |
Addresses
Primary practice location
31 Union St
Vernon, CT 06066-3126
Mailing address
11 Shoddy Mill Rd
Bolton, CT 06043-7817
Phone (860) 645-0115
Other providers in Vernon, CT
- Timothy J. Caouette
- Mary Neubelt Cardarelli
- Kelly Marie Carucci
- Jennifer Ann Caruso
- Andrew David Castillo
- Louise Giammona Caudullo
- Center for Family & Individual Psychotherapy, LLC
- Eleas J Chafouleas
- Mayank Chaliawala
- Chandra K. Sacheti, M.D., LLC
All providers in Vernon, CT · Emergency Medicine 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 Jul 9, 2007. 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.