Individual provider · NPI-1

Dr. Srinivasulu Conjeevaram, MD

Family Medicine · Colchester, CT

NPI number1780958058
StatusActive
Last updated in NPPESMar 24, 2023

Details

NPI
1780958058
Entity type
Individual (NPI-1)
Name
Dr. Srinivasulu Conjeevaram
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Mar 2, 2012
Certification date
Mar 24, 2023
Last updated
Mar 24, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine53644CTYes
207R00000X Internal Medicine53644CT
208D00000X General Practice4301086842MI
208D00000X General Practice53644CT

Practice location

100 Linwood Ave Ste 2a
Colchester, CT 06415-1138

Phone 860-415-3622 · Fax 860-974-0884

Mailing address

11 Winthrop Rd
Apt 2a
West Hartford, CT 06110-1656

Phone 860-415-3622 · Fax 860-540-1226

Other practice locations

421 Cottage Grove Rd Ste B
Bloomfield, CT 06002-3170

Phone 860-242-0034 · Fax 860-242-3301

146 Main Street
Somers, CT 06071-1825

Phone 860-415-3622 · Fax 860-540-1226

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