Healthcare Provider Details

I. General information

NPI: 1376579946
Provider Name (Legal Business Name): WAJIH ZAHEER KIDWAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WAJIH ZAHEER MD

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 GOOSE LANE SUITE 1300
GUILFORD CT
06437
US

IV. Provider business mailing address

300 GEORGE ST 6TH FLOOR
NEW HAVEN CT
06511-6624
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-9192
  • Fax: 203-453-0875
Mailing address:
  • Phone: 203-785-6610
  • Fax: 203-785-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number031863
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: