Individual
JATUPOL KOSITSAWAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
263 FARMINGTON AVE, GERIATRIC DEPT., FARMINGTON, CT 06030-6232
(860) 679-8400
(860) 679-1867
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
049154
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841223286
—
CT
Enumeration date
07/09/2006
Last updated
09/29/2022
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