Provider Demographics
NPI:1952040354
Name:KOCHIASHVILI, AVTANDIL
Entity Type:Individual
Prefix:
First Name:AVTANDIL
Middle Name:
Last Name:KOCHIASHVILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GENGRAS CLINIC AT ST FRANCIS HOSPITAL
Mailing Address - Street 2:1000 ASYLUM ANENUE
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-714-4532
Mailing Address - Fax:860-714-8275
Practice Address - Street 1:GENGRAS CLINIC AT ST FRANCIS HOSPITAL
Practice Address - Street 2:1000 ASYLUM ANENUE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-4532
Practice Address - Fax:860-714-8275
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program