Pourkavoos Medical Center, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

039709 Issued in CT

Legal business name

POURKAVOOS MEDICAL CENTER, LLC

Practice address

35 Nod Rd
Suite 205
Avon, CT 06001-3826

Phone

(860) 676-0090

Fax

(860) 676-0040

NPI assigned

Dec 9, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Khosro Pourkavoos, MD

Title

Owner

Phone

(860) 676-0090

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1346543642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 NOD RD",
            "address_2": "SUITE 205",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013826",
            "telephone_number": "860-676-0090",
            "fax_number": "860-676-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 NOD RD",
            "address_2": "SUITE 205",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013826",
            "telephone_number": "860-676-0090",
            "fax_number": "860-676-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POURKAVOOS MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-09",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "POURKAVOOS",
        "authorized_official_first_name": "KHOSRO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-676-0090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "039709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001397092",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aubrey Nichole Poisson
• Aleksandra Poka
• Anna Poltorak
• Alexandra Nicole Poppiti
• Suganthee Pounraj
• Khosro Pourkavoos
• Ellen Preen, PSY.D.
• Present Awareness, LLC
• Kelly Proulx, PT
• Psychotherapy Solutions, LLC

• Family Medicine Physician in Avon, CT
• Providers in Avon, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.