Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 030513 | CT |
N | 111NI0900X | Internist | 030513 | CT |
Y | 207RH0003X | Hematology & Oncology | 030513 | CT |
NPI | 1043295033 |
---|---|
Provider Name | Kandhasamy Jagathambal |
First Address | Norwich, CT 06360-2700 |
Second Address | Norwich, CT 06360-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 22/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001305136 | (05) | CT |
010030513CT02 | BC BS (01) | CT |
0113958 | AETNA (01) | CT |
B12860 | (02) |