Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 044517 | CT |
NPI | 1023033149 |
---|---|
Provider Name | Sagar Mohan Phatak |
First Address | Middlebury, CT 06762-1835 |
Second Address | Middlebury, CT 06762-1835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I63343 | (02) | CT |