Provider Demographics
NPI:1336109719
Name:KASHYAP, NITU M (MD)
Entity Type:Individual
Prefix:
First Name:NITU
Middle Name:M
Last Name:KASHYAP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:789 HOWARD AVE
Mailing Address - Street 2:PRIMARY CARE CENTER
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-688-1341
Mailing Address - Fax:203-688-2525
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:PRIMARY CARE CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-688-1341
Practice Address - Fax:203-688-2525
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA223406207R00000X
CT048167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100878OtherWELFARE
J28591OtherBLUE SHIELD INDEMNITY
85974OtherCHILDRENS MEDICAL SECURIT
042472266OtherTRICARE CHAMPUS
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTHREE RIVERS
2146266OtherCIGNA HEALTH PLAN
7024702OtherAETNA US HEALTHCARE
92201OtherFALLON COMMUNITY HEALTH P
J28591OtherBLUE CARE ELECT
MA2100878Medicaid
468032OtherTUFTS HEALTH PLAN
5617298OtherFIRST HEALTH
85974OtherHEALTHY START
042472266OtherONE HEALTH PLAN
AA30953OtherHARVARD PILGRIM HEALTHCAR
J28591OtherBLUE SHIELD HMO BLUE
85974OtherHEALTHY START
MAA38225Medicare ID - Type Unspecified
A38225Medicare ID - Type UnspecifiedB