1912561358 NPI number — RAVNEET SINGH RANDHAWA MD

Table of content: RAVNEET SINGH RANDHAWA MD (NPI 1912561358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912561358 NPI number — RAVNEET SINGH RANDHAWA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANDHAWA
Provider First Name:
RAVNEET
Provider Middle Name:
SINGH
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:
1912561358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UCONN GRADUATE MEDICAL EDUCATION
Provider Second Line Business Mailing Address:
263 FARMINGTON AVENUE LM068
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06030-1921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-679-4763
Provider Business Mailing Address Fax Number:
860-679-4624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OUTPATIENT CLINIC
Provider Second Line Business Practice Location Address:
100 GRAND STREET
Provider Business Practice Location Address City Name:
NEW BRITAIN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-224-5261
Provider Business Practice Location Address Fax Number:
860-224-5957
Provider Enumeration Date:
04/30/2019

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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