MEDICARE: DR. RAJNISH TANDON 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	208600000X	Surgery Physician	045550	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2822868	OTHER	CT	UNITED HEALTH CARE
2	9693073	OTHER	CT	US HEALTHCARE
3	6179898	OTHER	CT	CIGNA
4	9693073	OTHER	CT	AETNA
5	P3830539	OTHER	CT	OXFORD
6	010045550CT01	OTHER	CT	ANTHEM BLUE CROSS
7	1972707040	OTHER		NPI
8	045550	OTHER	CT	CONNECTICARE
9	3V0039	OTHER	CT	HEALTHNET

General Provider Information

NPI Number	:	1972707040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJNISH TANDON M.D.

Provider Business Mailing Address
First Line	:	300 HEBRON AVE STE 211
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-2192
Country	:	US
Telephone Number	:	860-522-1024
Fax Number	:	860-278-4613

Provider Business Practice Location Address
First Line	:	300 HEBRON AVE
Second Line	:	STE 211
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-2192
Country	:	US
Telephone Number	:	860-522-1024
Fax Number	:	860-278-4613

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/17/2024

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