GARY FUDEM MD (Credential# 241865) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2003. The license expiration date date is February 28, 2004. The license status is INACTIVE.
GARY FUDEM MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0030058. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2003. The expiration date is February 28, 2004. The business address is University of Mass. Center, Worcester, MA 01655. The current status is inactive.
| Licensee Name | GARY FUDEM MD |
| Credential ID | 241865 |
| Credential Number | CSP.0030058 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
University of Mass. Center Worcester MA 01655 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE |
| Effective Date | 2003-03-01 |
| Expiration Date | 2004-02-28 |
| Refresh Date | 2009-01-26 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 547788 | 1.029447 | Physician/Surgeon | 1988-09-09 | 2002-10-04 - 2003-11-30 | INACTIVE |
| Street Address | UNIVERSITY OF MASS. CENTER |
| City | WORCESTER |
| State | MA |
| Zip Code | 01655 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Carolina Ionete | 55 Lake Avenue, Worcester, MA 01655 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Thomas J Fitzgerald | 55 Lake Ave, N, Worcester, MA 01655 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Majaz Moonis Md | Umassmemorial Health Care, Neurology, 55 Lake Ave, Worcester, MA 01655 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Ari Wilkenfeld | Neurology Department � 5th Floor, Worcester, MA 01655 | Physician/surgeon | ~ |
| Kate Daniello | 55 N Lake Ave, Worcester, MA 01655 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Brian Silver | 55 Lake Avenue North, Worcester, MA 01655 | Physician/surgeon | 2020-01-01 ~ 2020-12-31 |
| Andrew Bouley | Umass Memorial, Department of Neurology, Worcester, MA 01655 | Physician/surgeon | 2019-04-01 ~ 2020-03-31 |
| Cheryl A Laflamme Aprn | 58 Bentwood Dr, Sturbridge, MA 01655 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Lawrence S Rosenthal Md | Umass Memorial Medical Center, Worcester, MA 01655 | Physician/surgeon | 2016-08-01 ~ 2017-07-31 |
| Daniel Z Fisher Md | 55 Lake Ave North, Worcester, MA 01655 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Find all Licenses in zip 01655 | |||
| City | WORCESTER |
| Zip Code | 01655 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + WORCESTER |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Gary J Dee | 101 No Plains, Wallingford, CT 06492 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Melanie J Koumentakos | 1 Gary Dr, Westfield, MA 01085-4553 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Gary Poupko Md | 34 Collins St, Waterbury, CT 06704 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Cheri P Nguyen | 41 Gary Rd, Enfield, CT 06082-2645 | Controlled Substance Registration for Practitioner | 2013-02-20 ~ 2015-02-28 |
| Gary H Janof Dmd | 39 Mallett Dr, Trumbull, CT 06611 | Controlled Substance Registration for Practitioner | 2002-03-01 ~ 2003-02-28 |
| Gary L Berman | 720 Main St, Willimantic, CT 06226-2648 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Gary R Steinberg Jr | 28 Somerset Rd, Glastonbury, CT 06033-1734 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Gary Cardoso | 129 York St Apt 7d, New Haven, CT 06511-5606 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Gary S Rappaport Dmd | 90 Hall Dr, Orange, CT 06477-2543 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| K Gary Vanasse Md | 52 Churchill Rd, Hamden, CT 06517 | Controlled Substance Registration for Practitioner | 2007-03-01 ~ 2008-02-29 |
Please comment or provide details below to improve the information on GARY FUDEM MD.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).