Individual
SUMIT TICKOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24 HOSPITAL AVE, DANBURY, CT 06810-6099
(203) 739-6959
Mailing address
24 HOSPITAL AVE, DANBURY, CT 06870
(203) 739-7436
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
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