Healthcare Provider Details

I. General information

NPI: 1992920276
Provider Name (Legal Business Name): ABHIJAY PRABHAKAR KARANDIKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 TOWN ST SUITE 300
NORWICH CT
06360-2316
US

IV. Provider business mailing address

112 LAFAYETTE ST
NORWICH CT
06360-2737
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-0567
  • Fax: 860-886-0656
Mailing address:
  • Phone: 860-425-8735
  • Fax: 860-425-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number017688
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number054563
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number054563
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: