Provider Demographics
NPI:1588838155
Name:KAINKARYAM, VASANTH (MD)
Entity type:Individual
Prefix:DR
First Name:VASANTH
Middle Name:
Last Name:KAINKARYAM
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 1:1199 SULLIVAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2013
Mailing Address - Country:US
Mailing Address - Phone:860-469-5646
Mailing Address - Fax:860-310-1122
Practice Address - Street 1:1199 SULLIVAN AVE STE A
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2013
Practice Address - Country:US
Practice Address - Phone:860-469-5646
Practice Address - Fax:860-310-1122
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050695208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1588838155OtherNPI