MEDICARE: DR. HOUSEIN M WAZAZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	038168	CT

General Provider Information

NPI Number	:	1629077714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOUSEIN M WAZAZ M.D.

Provider Business Mailing Address
First Line	:	455 LEWIS AVE
Second Line	:	SUITE 105
City	:	MERIDEN
State	:	CT
Zip	:	06451-2121
Country	:	US
Telephone Number	:	203-237-2477
Fax Number	:	203-238-1839

Provider Business Practice Location Address
First Line	:	455 LEWIS AVE
Second Line	:	SUITE 105
City	:	MERIDEN
State	:	CT
Zip	:	06451-2121
Country	:	US
Telephone Number	:	203-237-2477
Fax Number	:	203-238-1839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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