Healthcare Provider Details

I. General information

NPI: 1457855140
Provider Name (Legal Business Name): PRATISTHA KOIRALA MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CONNECTICUT AVE
NORWALK CT
06854-1525
US

IV. Provider business mailing address

120 CONNECTICUT AVE
NORWALK CT
06854-1525
US

V. Phone/Fax

Practice location:
  • Phone: 203-851-1000
  • Fax:
Mailing address:
  • Phone: 203-851-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036181505
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1.072436
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: