=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700817293
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAJANI P NADKARNI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 08/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 LEWIS AVE SUITE 102
-----------------------------------------------------
City | MEINDEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-238-7747
-----------------------------------------------------
Fax | 203-686-0282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 LUNAR DR
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06525-2320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-389-7504
-----------------------------------------------------
Fax | 203-389-1666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 033151
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------