Provider Demographics
NPI:1073506317
Name:NATARAJAN, GANESH C (MD)
Entity Type:Individual
Prefix:DR
First Name:GANESH
Middle Name:C
Last Name:NATARAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 FEDERAL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1144
Mailing Address - Country:US
Mailing Address - Phone:203-740-2881
Mailing Address - Fax:203-740-8653
Practice Address - Street 1:940 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1144
Practice Address - Country:US
Practice Address - Phone:203-740-2881
Practice Address - Fax:203-740-8653
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039487207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001394874Medicaid
CT290000392Medicare ID - Type Unspecified
CT001394874Medicaid