Provider Demographics
NPI:1639600927
Name:NANDA, TAVISH (MD)
Entity Type:Individual
Prefix:
First Name:TAVISH
Middle Name:
Last Name:NANDA
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 1:191 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3574
Mailing Address - Country:US
Mailing Address - Phone:860-646-7704
Mailing Address - Fax:860-474-3620
Practice Address - Street 1:191 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3574
Practice Address - Country:US
Practice Address - Phone:860-646-7704
Practice Address - Fax:860-474-3620
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT75452207WX0107X
MA286882207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist