1285631531 NPI number — HIROYOSHI TAKATA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285631531 NPI number — HIROYOSHI TAKATA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAKATA
Provider First Name:
HIROYOSHI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285631531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 33440
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06150-3440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-522-7181
Provider Business Mailing Address Fax Number:
860-278-3357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 SEYMOUR ST
Provider Second Line Business Practice Location Address:
SUITE 325
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-522-7181
Provider Business Practice Location Address Fax Number:
860-278-3357
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  015580 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P1302032 . This is a "OXFORD HEALTHPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 00155803 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2008073 . This is a "AETNA HMO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061028513 . This is a "COMMUNITY HEALTH NTWK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 330000473 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4125205 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010015580CT01 . This is a "ANTHEM BLUECROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061028513 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 071149 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010015580CT01 . This is a "BLUECARE FAMILY PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: OV7423 . This is a "HEALTHNET OF NE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0196966 . This is a "CIGNA HEALTHPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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