Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 024267 | CT |
NPI | 1003883992 |
---|---|
Provider Name | Dr. Asha V Manaktala |
First Address | West Hartford, CT 06117 |
Second Address | Windsor, CT 06095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010024267CT02 | ANTHEM BCBS (01) | CT |
020267 | CONNECTICARE (01) | CT |
04058400 | (05) | CT |