Provider Demographics
NPI:1093197634
Name:KANNAN, AARTHI (MBBS)
Entity Type:Individual
Prefix:
First Name:AARTHI
Middle Name:
Last Name:KANNAN
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 RETREAT AVENUE
Mailing Address - Street 2:HARTFORD HOSPITAL ADULT PRIMARY CARE - BROWN STONE
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06102
Mailing Address - Country:US
Mailing Address - Phone:860-545-0200
Mailing Address - Fax:860-545-3149
Practice Address - Street 1:79 RETREAT AVENUE
Practice Address - Street 2:HARTFORD HOSPITAL ADULT PRIMARY CARE - BROWN STONE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102
Practice Address - Country:US
Practice Address - Phone:860-545-0200
Practice Address - Fax:860-545-3149
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2016-06-02
Deactivation Date:2016-01-25
Deactivation Code:
Reactivation Date:2016-05-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program