Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 047888 | CT |
N | 207RI0011X | Interventional Cardiology | 047888 | CT |
NPI | 1003016957 |
---|---|
Provider Name | Dr. Shishir Mathur |
First Address | Glastonbury, CT 06033-7208 |
Second Address | Glastonbury, CT 06033-7208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 26/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003016957 | (05) | CT |