Basic Information
| Provider Information | |||||||||
| NPI: | 1538144522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAPUR | ||||||||
| FirstName: | DINESH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 WASHINGTON ST SUITE 220 | ||||||||
| Address2: | EASTERN CT HEMATOLOGY & ONCOLOGY | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608868362 | ||||||||
| FaxNumber: | 8608869262 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 WASHINGTON ST SUITE 220 | ||||||||
| Address2: | EASTERN CT HEMATOLOGY & ONCOLOGY | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608868362 | ||||||||
| FaxNumber: | 8608869262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 07/22/2013 | ||||||||
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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 | 207RH0003X | 036816 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207R00000X | 036816 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001368168 | 05 | CT | MEDICAID | 010036816CT02 | 01 | CT | BCBS | OTHER | 2123661 | 01 | CT | AETNA | OTHER |