1104267079 NPI number — MR. NAVEEN GNANABAKTHAN MD

Table of content: MR. NAVEEN GNANABAKTHAN MD (NPI 1104267079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104267079 NPI number — MR. NAVEEN GNANABAKTHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GNANABAKTHAN
Provider First Name:
NAVEEN
Provider Middle Name:
Provider Name Prefix Text:
MR.
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:
1104267079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 SOLANA BLVD BLDG. 2 SUITE 2200
Provider Second Line Business Mailing Address:
SOUND PHYSICIANS
Provider Business Mailing Address City Name:
WESTLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-767-6115
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 UNION STREET
Provider Second Line Business Practice Location Address:
ROCKVILLE GENERAL HOSPITAL
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-533-6595
Provider Business Practice Location Address Fax Number:
860-533-6594
Provider Enumeration Date:
07/08/2013

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: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 54659 , 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)





Copyright © 2007-2025 www.npivalidator.com