Healthcare Provider Details

I. General information

NPI: 1417215161
Provider Name (Legal Business Name): SOHAIB JAMIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 DALE RD
AVON CT
06001
US

IV. Provider business mailing address

30 JORDAN LN STE 3
WETHERSFIELD CT
06109-1244
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-8830
  • Fax:
Mailing address:
  • Phone: 860-263-0253
  • Fax: 860-263-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number283990
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number63813
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: