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General NPI Number Information
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NPI Number | 1083601256
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Entity Type | Individual
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Provider Name | ANIL K VITHALA MD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 477 CONNECTICUT BLVD SUITE 112
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City | EAST HARTFORD
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State | CT
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Zip | 06108-3268
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Country | US
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Telephone | 860-289-0623
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Fax |
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Provider Business Mailing Address
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Address Line | 477 CONNECTICUT BLVD SUITE 112
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City | EAST HARTFORD
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State | CT
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Zip | 06108-3268
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Country | US
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Telephone | 860-289-0623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 034801
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License Number State | CT
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