Provider Demographics
NPI:1679687065
Name:VANI, VEENA (MD)
Entity Type:Individual
Prefix:
First Name:VEENA
Middle Name:
Last Name:VANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:935 MAIN ST
Practice Address - Street 2:LEVEL A
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6059
Practice Address - Country:US
Practice Address - Phone:860-430-9004
Practice Address - Fax:860-781-6468
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001325324Medicaid
CTF82452Medicare UPIN
CT110009300Medicare ID - Type Unspecified