Provider Demographics
NPI:1699721886
Name:OLOFINBOBA, TRUDY (MD)
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:OLOFINBOBA
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 1:8 FARMINGTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2456
Mailing Address - Country:US
Mailing Address - Phone:860-614-8573
Mailing Address - Fax:
Practice Address - Street 1:99 E RIVER DR
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3288
Practice Address - Country:US
Practice Address - Phone:860-282-0833
Practice Address - Fax:860-282-0170
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036349207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001363499Medicaid
CT050001184Medicare PIN
E59833Medicare UPIN