Individual
ANN R DATUNASHVILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
874 HOWARD AVE, NEW HAVEN, CT 06519-1106
(203) 688-8200
(203) 688-8204
Mailing address
874 HOWARD AVE, NEW HAVEN, CT 06519-1106
(203) 688-8200
(203) 688-8204
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
039938
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001399387
—
CT
01
—
010039938CT01
ANTHEM BC/BS
CT
01
—
039938
CONNECTICARE
CT
01
—
061561581
HEALTH CT
CT
01
—
2V6380
HEALTH NET
CT
01
—
3621604
AETNA
CT
01
—
367593
WELLCARE OF CT
CT
01
—
P00132026
RAIL ROAD MEDICARE
CT
01
—
P3307906
OXFORD
CT
Enumeration date
08/04/2005
Last updated
03/24/2017
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