Healthcare Provider Details

I. General information

NPI: 1285749952
Provider Name (Legal Business Name): SACHIN R PAREKH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST EMERGENCY DEPT
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

25 BRADLEY WAY
GLASTONBURY CT
06033-3273
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4701
  • Fax:
Mailing address:
  • Phone: 860-633-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number043728
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number043728
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTPME824
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301500532
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA09468000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: