Provider Demographics
NPI:1124009964
Name:SRITHARAN, KANDIAH (MD)
Entity Type:Individual
Prefix:
First Name:KANDIAH
Middle Name:
Last Name:SRITHARAN
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 1:980 WHALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1733
Mailing Address - Country:US
Mailing Address - Phone:203-387-2569
Mailing Address - Fax:203-387-9245
Practice Address - Street 1:980 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1733
Practice Address - Country:US
Practice Address - Phone:203-387-2569
Practice Address - Fax:203-387-9245
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1222876Medicaid
CT1222876Medicaid
CTB84315Medicare UPIN