Provider Demographics
NPI:1104267079
Name:GNANABAKTHAN, NAVEEN (MD)
Entity type:Individual
Prefix:MR
First Name:NAVEEN
Middle Name:
Last Name:GNANABAKTHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SOLANA BLVD BLDG. 2 SUITE 2200
Mailing Address - Street 2:SOUND PHYSICIANS
Mailing Address - City:WESTLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262
Mailing Address - Country:US
Mailing Address - Phone:817-767-6115
Mailing Address - Fax:
Practice Address - Street 1:31 UNION STREET
Practice Address - Street 2:ROCKVILLE GENERAL HOSPITAL
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066
Practice Address - Country:US
Practice Address - Phone:860-533-6595
Practice Address - Fax:860-533-6594
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT54659208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program