Provider Demographics
NPI:1194706416
Name:GARCIA TSAO, GUADALUPE (MD)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:GARCIA TSAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GEORGE ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 TEMPLE ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2715
Practice Address - Country:US
Practice Address - Phone:203-785-4138
Practice Address - Fax:203-737-1345
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026146207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001261461Medicaid
CT110003680Medicare ID - Type Unspecified
E54710Medicare UPIN