1376657080 NPI number — IBRAHIM M DAOUD MD

Table of content: IBRAHIM M DAOUD MD (NPI 1376657080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376657080 NPI number — IBRAHIM M DAOUD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAOUD
Provider First Name:
IBRAHIM
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376657080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 WOODLAND ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-1290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-6871
Provider Business Mailing Address Fax Number:
860-714-6888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 WOODLAND ST FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-6871
Provider Business Practice Location Address Fax Number:
860-714-6888
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  017793 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010017793CT06 . This is a "BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010017793CT09 . This is a "BCBS NEWINGTON" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2334262 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3962278 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001177930 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010017793CT08 . This is a "BCBS WETHERSFIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 202928529 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 720239 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010017793CT07 . This is a "BCBS ROCKYHILL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P471096 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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