Provider Demographics
NPI:1104875640
Name:SATHISHCHANDAR, BALAKRISHNAN (MD)
Entity type:Individual
Prefix:
First Name:BALAKRISHNAN
Middle Name:
Last Name:SATHISHCHANDAR
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 1:287 WALSH AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3542
Mailing Address - Country:US
Mailing Address - Phone:860-436-2732
Mailing Address - Fax:
Practice Address - Street 1:2457 E MAIN ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2685
Practice Address - Country:US
Practice Address - Phone:203-753-8477
Practice Address - Fax:203-757-2617
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E07625Medicare UPIN