Healthcare Provider Details

I. General information

NPI: 1922299098
Provider Name (Legal Business Name): VINOD V PATHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LAFAYETTE ST
NORWICH CT
06360-2737
US

IV. Provider business mailing address

330 WASHINGTON ST SUITE 410
NORWICH CT
06360-2700
US

V. Phone/Fax

Practice location:
  • Phone: 860-425-8701
  • Fax:
Mailing address:
  • Phone: 860-425-5300
  • Fax: 860-425-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number045607
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number045607
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: