Provider Demographics
NPI:1346246444
Name:BALESWAREN, ANANDHI (MD)
Entity Type:Individual
Prefix:
First Name:ANANDHI
Middle Name:
Last Name:BALESWAREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANANDHI
Other - Middle Name:
Other - Last Name:PATHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:481 GOLD STAR HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6702
Mailing Address - Country:US
Mailing Address - Phone:860-446-8858
Mailing Address - Fax:860-405-2140
Practice Address - Street 1:481 GOLD STAR HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6702
Practice Address - Country:US
Practice Address - Phone:860-446-8858
Practice Address - Fax:860-405-2140
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038604207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001386045Medicaid
H38813Medicare UPIN
CT110008237Medicare ID - Type Unspecified