Healthcare Provider Details

I. General information

NPI: 1346246444
Provider Name (Legal Business Name): ANANDHI BALESWAREN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANANDHI PATHMAN MD

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 11/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 GOLD STAR HWY SUITE 100
GROTON CT
06340-6702
US

IV. Provider business mailing address

481 GOLD STAR HWY SUITE 100
GROTON CT
06340-6702
US

V. Phone/Fax

Practice location:
  • Phone: 860-446-8858
  • Fax: 860-405-2140
Mailing address:
  • Phone: 860-446-8858
  • Fax: 860-405-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number038604
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number038604
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: