Provider Demographics
NPI:1811005713
Name:AITHAL, KESHAVA H (MD)
Entity Type:Individual
Prefix:
First Name:KESHAVA
Middle Name:H
Last Name:AITHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:420 SAYBROOK RD
Mailing Address - Street 2:STE A
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4747
Mailing Address - Country:US
Mailing Address - Phone:860-636-2010
Mailing Address - Fax:
Practice Address - Street 1:420 SAYBROOK RD
Practice Address - Street 2:MIDDLESEX CARDIOLOGY ASSOCIATES
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4747
Practice Address - Country:US
Practice Address - Phone:860-347-4258
Practice Address - Fax:860-704-5924
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT022621207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
00122621600OtherEDS BLUE CARE
CT00122621600Medicaid
OVO216OtherHEALTH NET
052155OtherCT
P1539752OtherOXFORD
010022621CT01OtherANTHEM
593866005OtherCIGNA
0000199534901OtherUNITED HC
210494OtherAETNA
0000199534901OtherUNITED HC
00122621600OtherEDS BLUE CARE