| Doctor Name: | DR. ASHUTOSH PATHAK |
| NPI Number: | 1114121423 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 4301088965 |
| Business Practice Address: | Veteran Affairs Medical Center 950 Campell Avenue West Haven, CT - 06516 |
| Business Phone Number: | 2039325711 |
| Business Fax Number: | |
| Mailing Address: | 750 Whitney Ave, Aptt# C 12 NEW HAVEN |
| State: | CT |
| Postal Code: | 065111358 |
| Phone Number: | 2033143259 |
| Fax Number: | |
| NPI Enumeration Date: | 06/12/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | 4301088965 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |