Individual
MRS. KANTHIMATHI JEGATHESAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2271 EAST MAIN STREET, WATERBURY, CT 06705
(203) 753-4131
(203) 753-6887
Mailing address
2271 EAST MAIN STREET, WATERBURY, CT 06705
(203) 753-4131
(203) 753-6887
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
026217
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001262170
—
CT
01
—
010026217CT01
BCBS
CT
01
—
0R1849
HEALTH NET
CT
Enumeration date
09/11/2006
Last updated
07/08/2007
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