Provider Demographics
NPI:1417985946
Name:TANDON, PRIYA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:TANDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PARK AVE
Mailing Address - Street 2:SUITE1
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1128
Mailing Address - Country:US
Mailing Address - Phone:860-537-2309
Mailing Address - Fax:888-297-2226
Practice Address - Street 1:7 PARK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1128
Practice Address - Country:US
Practice Address - Phone:860-537-2309
Practice Address - Fax:888-297-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001351154Medicaid
CTG36363Medicare UPIN
CT001351154Medicaid