Healthcare Provider Details

I. General information

NPI: 1326466517
Provider Name (Legal Business Name): PETER HASHIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BUSINESS PARK DR STE 204
BRANFORD CT
06405-2988
US

IV. Provider business mailing address

6 SHAWS CV STE 204
NEW LONDON CT
06320-4969
US

V. Phone/Fax

Practice location:
  • Phone: 203-208-4082
  • Fax:
Mailing address:
  • Phone: 860-440-3744
  • Fax: 860-440-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number85759
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number280687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: