Provider Demographics
NPI:1972707040
Name:TANDON, RAJNISH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJNISH
Middle Name:
Last Name:TANDON
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 1:300 HEBRON AVE
Mailing Address - Street 2:STE 211
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2192
Mailing Address - Country:US
Mailing Address - Phone:860-522-1024
Mailing Address - Fax:860-278-4613
Practice Address - Street 1:300 HEBRON AVE
Practice Address - Street 2:STE 211
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2192
Practice Address - Country:US
Practice Address - Phone:860-522-1024
Practice Address - Fax:860-278-4613
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045550208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3V0039OtherHEALTHNET
CTP3830539OtherOXFORD
CT010045550CT01OtherANTHEM BLUE CROSS
CT2822868OtherUNITED HEALTH CARE
CT9693073OtherAETNA
1972707040OtherNPI
CT6179898OtherCIGNA
CT9693073OtherUS HEALTHCARE
CT045550OtherCONNECTICARE