Provider Demographics
NPI:1598869596
Name:KANAGARATNAM JEGATHESAN MD PC
Entity Type:Organization
Organization Name:KANAGARATNAM JEGATHESAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF THE CORPORATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANTHIMAJHI
Authorized Official - Middle Name:
Authorized Official - Last Name:JEGATHESAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-753-4131
Mailing Address - Street 1:2271 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705
Mailing Address - Country:US
Mailing Address - Phone:203-753-4131
Mailing Address - Fax:203-753-6887
Practice Address - Street 1:2271 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705
Practice Address - Country:US
Practice Address - Phone:203-753-4131
Practice Address - Fax:203-753-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT50KJEGATHCT01OtherBCBS
CTC00815Medicare ID - Type Unspecified