Healthcare Provider Details

I. General information

NPI: 1437146776
Provider Name (Legal Business Name): SETU K VORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CASE ST STE 204
NORWICH CT
06360
US

IV. Provider business mailing address

12 HARVEST GLN
EAST LYME CT
06333-1556
US

V. Phone/Fax

Practice location:
  • Phone: 860-319-0470
  • Fax: 860-319-0398
Mailing address:
  • Phone: 860-319-0470
  • Fax: 860-319-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42770
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number042770
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: