1790914547 NPI number — DR. THEJAS N SWAMY MD

Table of content: DR. THEJAS N SWAMY MD (NPI 1790914547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790914547 NPI number — DR. THEJAS N SWAMY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAMY
Provider First Name:
THEJAS
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1790914547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 SAYBROOK RD STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06457-4743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-344-8606
Provider Business Mailing Address Fax Number:
860-344-8963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 SAYBROOK RD STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06457-4743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-344-8606
Provider Business Practice Location Address Fax Number:
860-344-8963
Provider Enumeration Date:
07/14/2009

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: 207RN0300X , with the licence number:  051699 , 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: 5955504 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2539259 . This is a "COVENTRY/FIRST HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 929297 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 5295851 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P4854527 . This is a "UHC/OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1790914547 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01262027 . This is a "RAILROAD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 051699 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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