Provider Demographics
NPI:1548920457
Name:HAMDEN MEDICAL LLC
Entity type:Organization
Organization Name:HAMDEN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TELESFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-248-8142
Mailing Address - Street 1:2337 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3539
Mailing Address - Country:US
Mailing Address - Phone:203-248-8142
Mailing Address - Fax:203-248-7764
Practice Address - Street 1:2337 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3539
Practice Address - Country:US
Practice Address - Phone:203-248-8142
Practice Address - Fax:203-248-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care