| Organization Name: | GENERAL MEDICAL PRACTICE OF WEST HAVEN LLC |
| NPI Number: | 1285936559 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MALLASETAPPA SHIRANNA UMAPATHY (PHYSICIAN/OWNER) |
| Mailing Address: | 309 Main St West Haven |
| State: | CT US |
| Postal Code: | 065164424 |
| Phone Number: | 2039334001 |
| Fax Number: | 2039333759 |
| NPI Enumeration Date: | 11/18/2010 |
| NPI Last Update Date: | 11/18/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 025441 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |