Provider Demographics
NPI:1063532455
Name:RAI, RIPUDEEP (MD)
Entity type:Individual
Prefix:DR
First Name:RIPUDEEP
Middle Name:
Last Name:RAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RIPUDEEP
Other - Middle Name:
Other - Last Name:KAHLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2110 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2313
Mailing Address - Country:US
Mailing Address - Phone:860-258-3470
Mailing Address - Fax:860-571-6800
Practice Address - Street 1:100 RETREAT AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2528
Practice Address - Country:US
Practice Address - Phone:860-244-0148
Practice Address - Fax:860-493-1852
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110010621Medicare PIN