SUBRA - SIVA MD (Credential# 149523) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2017. The license expiration date date is February 28, 2019. The license status is LAPSED.
SUBRA - SIVA MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0001276. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2017. The expiration date is February 28, 2019. The business address is 30 Ridgewood Rd, Woodbury, CT 06798-3814. The current status is lapsed.
| Licensee Name | SUBRA - SIVA MD |
| Credential ID | 149523 |
| Credential Number | CSP.0001276 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
30 Ridgewood Rd Woodbury CT 06798-3814 |
| Business Type | INDIVIDUAL |
| Status | LAPSED |
| Active | 1 |
| Issue Date | 1999-03-01 |
| Effective Date | 2017-03-01 |
| Expiration Date | 2019-02-28 |
| Refresh Date | 2019-03-06 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 542784 | 1.018565 | Physician/Surgeon | 1977-01-10 | 2017-07-01 - 2018-06-30 | INACTIVE |
| Street Address | 30 RIDGEWOOD RD |
| City | WOODBURY |
| State | CT |
| Zip Code | 06798-3814 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Charlene J Eusebio · Rohrs | 46 Ridgewood Rd, Woodbury, CT 06798-3814 | Registered Nurse | 2020-04-01 ~ 2021-03-31 |
| Samantha Leigh Miles | 26 Ridgewood Rd, Woodbury, CT 06798-3814 | Registered Nurse | 2019-11-01 ~ 2020-10-31 |
| Jason Mucci | 20 Ridgewood Rd, Woodbury, CT 06798-3814 | Radiographer | 2019-09-01 ~ 2020-08-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Russell J Hardy | 229 Bacon Pond Rd #114, Woodbury, CT 06798 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Geoffrey S Middeleer | 20 Roxbury Road, Woodbury, CT 06798 | Landscape Architect | 2020-08-01 ~ 2021-07-31 |
| Elaine P Templeton | 197 Carmel Hill Road, Woodbury, CT 06798 | Real Estate Salesperson | ~ |
| Ayrica L Gelinas | 65 Laurel Woods Road, Woodbury, CT 06798 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Christopher R Laux | Grey Fox Trail, Woodbury, CT 06798 | Architect | 2020-08-01 ~ 2021-07-31 |
| Diane L Robinson | P O Box 208, Woodbury, CT 06798 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Scott Freitag | 47 Woodbury Hill, Woodbury, CT 06798 | Medication Administration Certification | ~ |
| Brenda L Lupo | 31 Blueberry Lane, Woodbury, CT 06798 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Jennifer L Thompson | 1280 Main St. North, Woodbury, CT 06798 | Licensed Clinical Social Worker | 2020-08-01 ~ 2021-07-31 |
| Eileen O Pflegl | 3 Hazel Plain Road, Woodbury, CT 06798 | Hairdresser/cosmetician | 2020-08-01 ~ 2022-07-31 |
| Find all Licenses in zip 06798 | |||
| City | WOODBURY |
| Zip Code | 06798 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + WOODBURY |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kirubakaran Siva | 80 Winter Ln, Tewksbury, MA 01876-2256 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Kirubakaran Siva | 5305 Archstone Ave, Tewksbury, MA 01876-1872 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Siva Padmanabhan Sivakumar | 38 Ericka Cicle, East Longmeadow, MA 01028 | Controlled Substance Registration for Practitioner | 2019-12-18 ~ 2021-02-28 |
| Siva Yadlapati Md · Univ of Conn Health Ctr | Div of Homatology/oncology, Farmington, CT 06032 | Controlled Substance Registration for Practitioner | 1998-03-01 ~ 1999-02-28 |
| Siva Construction Inc | 17 Lafayette Avenue, Ridgefield, CT 06877 | Home Improvement Contractor | 1995-02-01 ~ 1995-11-30 |
| Sergio I Vazquez · Siva Construction Co Inc | 17 Lafayette Ave, Ridgefield, CT 06877 | Home Improvement Contractor | 1995-02-21 ~ 1995-11-30 |
| Steven Kassels Md · Community Substance Abuse Center | Comm. Physicians PC/125 North Elm Street, Westfield, MA 01085 | Controlled Substance Registration for Practitioner | 2018-06-15 ~ 2019-02-28 |
| Shu-i Lin | CT | Controlled Substance Registration for Practitioner | 2017-06-12 ~ 2019-02-28 |
| Huu Duc D Luu | 630 Mix Ave Apt 6p, Hamden, CT 06514-2320 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Qi Che Md | Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2006-03-01 ~ 2007-02-28 |
Please comment or provide details below to improve the information on SUBRA - SIVA 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).