Healthcare Provider Details

I. General information

NPI: 1437341948
Provider Name (Legal Business Name): MEGHANA GAIKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JOLLEY DR SUITE 203
BLOOMFIELD CT
06002-3062
US

IV. Provider business mailing address

35 JOLLEY DR SUITE 203
BLOOMFIELD CT
06002-3062
US

V. Phone/Fax

Practice location:
  • Phone: 860-769-7302
  • Fax: 860-769-7300
Mailing address:
  • Phone: 860-769-7302
  • Fax: 860-769-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number052128
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: