Healthcare Provider Details

I. General information

NPI: 1669412961
Provider Name (Legal Business Name): ADITYA R DAFTARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CHURCH STREET 3RD FLOOR
NEW HAVEN CT
06510-1805
US

IV. Provider business mailing address

205 CHURCH STREET 3RD FLOOR
NEW HAVEN CT
06510-1805
US

V. Phone/Fax

Practice location:
  • Phone: 203-773-0427
  • Fax: 775-242-2409
Mailing address:
  • Phone: 203-773-0427
  • Fax: 775-242-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number40584
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number057296
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number36115013
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number40584
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number057296
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36115013
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: