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General NPI Number Information
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NPI Number | 1598869596
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Entity Type | Organization
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Legal Business Name | KANAGARATNAM JEGATHESAN MD PC
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2271 EAST MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06705
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Country | US
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Telephone | 203-753-4131
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Fax | 203-753-6887
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Provider Business Mailing Address
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Address Line | 2271 EAST MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06705
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Country | US
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Telephone | 203-753-4131
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Fax | 203-753-6887
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Authorized Official
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Title or Position | SECRETARY OF THE CORPORATION
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Name | MRS. KANTHIMAJHI JEGATHESAN
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Credential | MD
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Telephone | 203-753-4131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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