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General NPI Number Information
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NPI Number | 1740776764
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Entity Type | Individual
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Provider Name | PIMEN KURASHVILI
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Gender | Male
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1000 E MAIN ST
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City | TORRINGTON
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State | CT
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Zip | 06790-3909
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Country | US
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Telephone | 860-496-6884
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Fax |
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HIGHWAY HHC - CVO
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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Country | US
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Telephone |
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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 | 67356
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License Number State | CT
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