Healthcare Provider Details

I. General information

NPI: 1407961741
Provider Name (Legal Business Name): JIAFAN QI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-3985
US

IV. Provider business mailing address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-3985
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2980
  • Fax: 860-679-4334
Mailing address:
  • Phone: 860-679-2980
  • Fax: 860-679-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number041515
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD12032
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: