Basic Information
| Provider Information | |||||||||
| NPI: | 1104267079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GNANABAKTHAN | ||||||||
| FirstName: | NAVEEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 SOLANA BLVD BLDG. 2 SUITE 2200 | ||||||||
| Address2: | SOUND PHYSICIANS | ||||||||
| City: | WESTLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177676115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 31 UNION STREET | ||||||||
| Address2: | ROCKVILLE GENERAL HOSPITAL | ||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605336595 | ||||||||
| FaxNumber: | 8605336594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | 54659 | CT | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.