Basic Information
| Provider Information | |||||||||
| NPI: | 1629652706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEKHAR | ||||||||
| FirstName: | RAJ | ||||||||
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| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | UCONN SCHOOL OF MEDICINE-GRADUATE MEDICAL EDUCATION | ||||||||
| Address2: | 263 FARMINGTON AVENUE -LM068 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060301921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606792147 | ||||||||
| FaxNumber: | 8606794624 | ||||||||
| Practice Location | |||||||||
| Address1: | BURGDORF CLINIC | ||||||||
| Address2: | 131 COVENTRY ST, 2ND FLOOR | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607143690 | ||||||||
| FaxNumber: | 8607148541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2021 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 05/06/2022 | ||||||||
| NPIReactivationDate: | 07/18/2022 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.