Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 038032 | CT |
N | 208600000X | Surgeon | 038032 | CT |
Y | 2086S0102X | Surgical Critical Care | 038032 | CT |
NPI | 1174504856 |
---|---|
Provider Name | Manish Tandon |
First Address | Boston, MA 02241-5933 |
Second Address | Hartford, CT 06102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 06/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001380328 | (05) | CT |
G55359 | (02) |