1912928177 NPI number — BECHARA BARRAK MD

Table of content: BECHARA BARRAK MD (NPI 1912928177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912928177 NPI number — BECHARA BARRAK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRAK
Provider First Name:
BECHARA
Provider Middle Name:
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:
1912928177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 ASYLUM AVE
Provider Second Line Business Mailing Address:
SUITE 3218
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-1770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-5415
Provider Business Mailing Address Fax Number:
860-714-8861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 COTTAGE GROVE RD STE D110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06002-3085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-530-2014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2006

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: 207R00000X , with the licence number:  032571 , 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: 001325712 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0V3685 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010032571CT01 . This is a "ANTHEM BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".