Healthcare Provider Details

I. General information

NPI: 1407900228
Provider Name (Legal Business Name): YAZEED S MAGHAYDAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/26/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE GERIATRIC MEDICINE
FARMINGTON CT
06030-6232
US

IV. Provider business mailing address

263 FARMINGTON AVE PROVIDER ENROLLMENT OFFICE
FARMINGTON CT
06030-2212
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-8400
  • Fax: 860-679-1867
Mailing address:
  • Phone: 860-679-7503
  • Fax: 860-679-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number043675
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: