Provider Demographics
NPI:1043295033
Name:JAGATHAMBAL, KANDHASAMY (MD)
Entity type:Individual
Prefix:
First Name:KANDHASAMY
Middle Name:
Last Name:JAGATHAMBAL
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 1:330 WASHINGTON ST
Mailing Address - Street 2:STE 220 EASTERN CT HEMATOLOGY & ONCOLOGY
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2700
Mailing Address - Country:US
Mailing Address - Phone:860-886-8362
Mailing Address - Fax:860-886-9262
Practice Address - Street 1:330 WASHINGTON ST
Practice Address - Street 2:STE 220 EASTERN CT HEMATOLOGY & ONCOLOGY
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2700
Practice Address - Country:US
Practice Address - Phone:860-886-8362
Practice Address - Fax:860-886-9262
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT030513207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010030513CT02OtherBC BS
CT0113958OtherAETNA
CT001305136Medicaid
CT0113958OtherAETNA
CT440000010Medicare PIN