Healthcare Provider Details

I. General information

NPI: 1881793511
Provider Name (Legal Business Name): MEDICAL CARE CENTER OF CHESHIRE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 HIGHLAND AVE
CHESHIRE CT
06410-2562
US

IV. Provider business mailing address

430 HIGHLAND AVE
CHESHIRE CT
06410-2562
US

V. Phone/Fax

Practice location:
  • Phone: 203-271-3132
  • Fax: 203-271-3940
Mailing address:
  • Phone: 203-271-3132
  • Fax: 203-271-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberME72340
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number034996
License Number StateCT

VIII. Authorized Official

Name: DR. HUSAM BAHGAT SHITIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-271-3132