MEDICARE: ANN R DATUNASHVILI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	039938	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00132026	OTHER	CT	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	061561581	OTHER	CT	HEALTH CT
2	P3307906	OTHER	CT	OXFORD
3	2V6380	OTHER	CT	HEALTH NET
4	367593	OTHER	CT	WELLCARE OF CT
6	039938	OTHER	CT	CONNECTICARE
7	010039938CT01	OTHER	CT	ANTHEM BC/BS
8	061561581	OTHER	CT	UNITED HEALTHCARE
9	3621604	OTHER	CT	AETNA
10	061561581	OTHER	CT	CIGNA
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376544932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN R DATUNASHVILI M.D.

Provider Business Mailing Address
First Line	:	874 HOWARD AVE
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06519-1106
Country	:	US
Telephone Number	:	203-688-8200
Fax Number	:	203-688-8204

Provider Business Practice Location Address
First Line	:	874 HOWARD AVE
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06519-1106
Country	:	US
Telephone Number	:	203-688-8200
Fax Number	:	203-688-8204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	03/24/2017

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