Provider Demographics
NPI:1457369944
Name:JASTHI, RADHIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:
Last Name:JASTHI
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 1:80 MILL RIVER STREET
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-487-6177
Mailing Address - Fax:203-487-6178
Practice Address - Street 1:80 MILL RIVER STREET
Practice Address - Street 2:SUITE 2200
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-487-6177
Practice Address - Fax:203-487-6178
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001401596Medicaid
110009035Medicare ID - Type Unspecified
CT001401596Medicaid