Individual
KAVITA PRABHAKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
Mailing address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 679-4225
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
045491
CT
Other
Enumeration date
06/07/2007
Last updated
01/28/2015
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