Provider Demographics
NPI:1487641601
Name:LATHI, KISHOR G (MD)
Entity Type:Individual
Prefix:
First Name:KISHOR
Middle Name:G
Last Name:LATHI
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 1:45 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7224
Mailing Address - Country:US
Mailing Address - Phone:914-713-4130
Mailing Address - Fax:
Practice Address - Street 1:1055 WASHINGTON BLVD
Practice Address - Street 2:SUITE 440
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2216
Practice Address - Country:US
Practice Address - Phone:203-348-2614
Practice Address - Fax:203-325-8677
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044999207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0190586Medicaid
MAE05839Medicare ID - Type Unspecified
B73854Medicare UPIN