Provider Demographics
NPI:1285631531
Name:TAKATA, HIROYOSHI (MD)
Entity Type:Individual
Prefix:
First Name:HIROYOSHI
Middle Name:
Last Name:TAKATA
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:PO BOX 33440
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06150-3440
Mailing Address - Country:US
Mailing Address - Phone:860-522-7181
Mailing Address - Fax:860-278-3357
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 325
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-522-7181
Practice Address - Fax:860-278-3357
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT015580208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP1302032OtherOXFORD HEALTHPLAN
CT00155803Medicaid
CT2008073OtherAETNA HMO
CT061028513OtherCOMMUNITY HEALTH NTWK
CT330000473OtherRAILROAD MEDICARE
CT4125205OtherAETNA
CT010015580CT01OtherANTHEM BLUECROSS
CT061028513OtherUNITED HEALTHCARE
CT071149OtherCONNECTICARE
CT010015580CT01OtherBLUECARE FAMILY PLAN
CTOV7423OtherHEALTHNET OF NE
CT0196966OtherCIGNA HEALTHPLAN
CT071149OtherCONNECTICARE
CT2008073OtherAETNA HMO