Provider Demographics
NPI:1144361841
Name:KONESWARAN, SAROJA (MD)
Entity type:Individual
Prefix:DR
First Name:SAROJA
Middle Name:
Last Name:KONESWARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HUNTINGTON PLAZA
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5211
Mailing Address - Country:US
Mailing Address - Phone:203-929-6358
Mailing Address - Fax:203-929-3826
Practice Address - Street 1:21 HUNTINGTON PLAZA
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-5211
Practice Address - Country:US
Practice Address - Phone:203-929-6358
Practice Address - Fax:203-929-3826
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B84085Medicare UPIN