Basic Information
| Provider Information | |||||||||
| NPI: | 1902874076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHETH | ||||||||
| FirstName: | SAVITA | ||||||||
| MiddleName: | NIRAV | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DUA | ||||||||
| OtherFirstName: | SAVITA | ||||||||
| OtherMiddleName: | ASHOK KUMAR | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 71 HAYNES ST | ||||||||
| Address2: | SUITE 1209 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060404131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605336595 | ||||||||
| FaxNumber: | 8605336594 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 HAYNES ST | ||||||||
| Address2: | SUITE 1209 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060404131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605336595 | ||||||||
| FaxNumber: | 8605336594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 08/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 42000 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 042000 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2V6239 | 01 | CT | HEALTHNET | OTHER | P3596065 | 01 | CT | OXFORD | OTHER | 010042000CT01 | 01 | CT | BC/BS | OTHER | 654714 | 01 | CT | CIGNA | OTHER | 001420009 | 05 | CT | MEDICAID | 3756455 | 01 | CT | AETNA | OTHER | C003687 | 01 | CT | CHAMPUS | OTHER | 00142000900 | 01 | CT | BC/BS FAMILYPLAN | OTHER | 042000 | 01 | CT | CONNECTICARE | OTHER |