Healthcare Provider Details

I. General information

NPI: 1437146057
Provider Name (Legal Business Name): SEYED ALEALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 POST RD
FAIRFIELD CT
06824-6232
US

IV. Provider business mailing address

425 POST RD
FAIRFIELD CT
06824-6232
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-4545
  • Fax: 203-254-1191
Mailing address:
  • Phone: 203-255-4545
  • Fax: 203-254-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number016827
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number016827
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: