Provider Demographics
NPI:1598109753
Name:AYYAGARI, RADHIKA NAGA (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:NAGA
Last Name:AYYAGARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1278
Mailing Address - Country:US
Mailing Address - Phone:602-630-2538
Mailing Address - Fax:860-263-0262
Practice Address - Street 1:PRIME HEALTHCARE PC
Practice Address - Street 2:44 DALE RD
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4320
Practice Address - Country:US
Practice Address - Phone:860-674-8830
Practice Address - Fax:860-674-8984
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63734207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty