Basic Information
| Provider Information | |||||||||
| NPI: | 1144676032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAMATH | ||||||||
| FirstName: | NITISHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 79 RETREAT AVE | ||||||||
| Address2: | HARTFORD HOSPITAL ADULT PRIMARY CARE BROWN STONE | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061062527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609720200 | ||||||||
| FaxNumber: | 8605453149 | ||||||||
| Practice Location | |||||||||
| Address1: | 79 RETREAT AVE | ||||||||
| Address2: | HARTFORD HOSPITAL ADULT PRIMARY CARE BROWN STONE | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061062527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609720200 | ||||||||
| FaxNumber: | 8605453149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2016 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2022 | ||||||||
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 | 0101266305 | VA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0101266305 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.