1134129646 NPI number — DR. DARIUSH OWLIA M.D.

Table of content: DR. DARIUSH OWLIA M.D. (NPI 1134129646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134129646 NPI number — DR. DARIUSH OWLIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWLIA
Provider First Name:
DARIUSH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1134129646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WHITFIELD HTS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06001-3955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-965-2055
Provider Business Mailing Address Fax Number:
860-677-6850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 RETREAT AVE
Provider Second Line Business Practice Location Address:
SUITE 811
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-522-5712
Provider Business Practice Location Address Fax Number:
860-520-4270
Provider Enumeration Date:
07/26/2005

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: 207RC0000X , with the licence number:  017276 , 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: OS2420 . This is a "HEALTHNET INS. ID#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001172766 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: P12038310 . This is a "MULTIPLAN ID#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 052169-0446 . This is a "CONNECTICARE INS. ID #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 781651 . This is a "AETNA INS. ID #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0184408002 . This is a "CIGNA HEALTHPLAN ID#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010017276CT01 . This is a "ANTHEM BC/BS ID#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P1302020 . This is a "OXFORD HEALTHPLANS ID#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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