Individual
SUMIT TICKOO
Active
Individual
SUMIT TICKOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
44573
CT
207RI0011X
Interventional Cardiology Physician
Primary
44573
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0-625-499-9
ECFMG CERTIFICATE #
—
05
—
008032248
—
CT
01
—
010044573CT05
ANTHEM BCBS CT
CT
01
—
02289243
COVENTRY/FIRST HEALTH
CT
01
—
044573
CONNECTICARE
CT
01
—
1167116
USA
CT
01
—
7196206
CIGNA
CT
01
—
9244670
AETNA
CT
01
—
P4525993
OXFORD
CT
01
—
PENDING CLAIM
RR MEDICARE
CT
Enumeration date
06/20/2007
Last updated
07/17/2014
Update your record
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