1437146776 NPI number — SETU K VORA MD

Table of content: SETU K VORA MD (NPI 1437146776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437146776 NPI number — SETU K VORA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VORA
Provider First Name:
SETU
Provider Middle Name:
K
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:
1437146776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 HARVEST GLN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST LYME
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06333-1556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-319-0470
Provider Business Mailing Address Fax Number:
860-319-0398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 CASE ST STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-319-0470
Provider Business Practice Location Address Fax Number:
860-319-0398
Provider Enumeration Date:
10/03/2005

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: 207RP1001X , with the licence number:  042770 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 42770 , 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: 042770 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042770 . This is a "NORTHEAST HEALTH DIRECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001427708 . This is a "MEDICAID OF CONNECTICUT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290000408 . This is a "MEDICARE OF CONNECTICUT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001427708 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010042770CT01 . This is a "BLUE SHIELD OF CONNECTICU" identifier . This identifiers is of the category "OTHER".




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