Provider Demographics
NPI:1972391514
Name:POTTABATHINI, RAHUL (MD)
Entity type:Individual
Prefix:MR
First Name:RAHUL
Middle Name:
Last Name:POTTABATHINI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ROBBINS STREET, WATERBURY HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:WATEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-573-6162
Mailing Address - Fax:203-357-6707
Practice Address - Street 1:160 ROBBINS STREET CHASE OUTPATIENT CENTER
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-573-7284
Practice Address - Fax:203-573-7031
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program