Healthcare Provider Details

I. General information

NPI: 1972868198
Provider Name (Legal Business Name): PRANAV KAPOOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 TOWER AVE STE 401
HARTFORD CT
06112-1264
US

IV. Provider business mailing address

95 WOODLAND ST FL 1
HARTFORD CT
06105-1230
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-2913
  • Fax: 860-714-8988
Mailing address:
  • Phone: 959-223-3923
  • Fax: 860-714-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55546
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: