Basic Information
| Provider Information | |||||||||
| NPI: | 1285631531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAKATA | ||||||||
| FirstName: | HIROYOSHI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 33440 | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061503440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605227181 | ||||||||
| FaxNumber: | 8602783357 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 SEYMOUR ST | ||||||||
| Address2: | SUITE 325 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061065501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605227181 | ||||||||
| FaxNumber: | 8602783357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 015580 | CT | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | P1302032 | 01 | CT | OXFORD HEALTHPLAN | OTHER | 00155803 | 05 | CT | MEDICAID | 2008073 | 01 | CT | AETNA HMO | OTHER | 061028513 | 01 | CT | COMMUNITY HEALTH NTWK | OTHER | 330000473 | 01 | CT | RAILROAD MEDICARE | OTHER | 4125205 | 01 | CT | AETNA | OTHER | 010015580CT01 | 01 | CT | ANTHEM BLUECROSS | OTHER | 061028513 | 01 | CT | UNITED HEALTHCARE | OTHER | 071149 | 01 | CT | CONNECTICARE | OTHER | 010015580CT01 | 01 | CT | BLUECARE FAMILY PLAN | OTHER | OV7423 | 01 | CT | HEALTHNET OF NE | OTHER | 0196966 | 01 | CT | CIGNA HEALTHPLAN | OTHER |