Provider Demographics
NPI:1265445712
Name:TANDON, KISHAN N (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHAN
Middle Name:N
Last Name:TANDON
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 1:290 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1549
Mailing Address - Country:US
Mailing Address - Phone:860-522-1024
Mailing Address - Fax:860-278-4613
Practice Address - Street 1:290 COLLINS ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1549
Practice Address - Country:US
Practice Address - Phone:860-522-1024
Practice Address - Fax:860-278-4613
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016666208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V5398OtherHEALTH NET
CT00116666901OtherBLUECARE FAMILY PLAN
CT010016666CT02OtherANTHEM BLUE CROSS
CT3372265OtherUS HEALTHCARE
CTHAS502OtherOXFORD
CT3372265OtherAETNA
CT0210784OtherCIGNA
CT1166669Medicaid
CT733577OtherCONNECTICARE
CT00116666901OtherBLUECARE FAMILY PLAN
CT0210784OtherCIGNA