Healthcare Provider Details

I. General information

NPI: 1134129646
Provider Name (Legal Business Name): DARIUSH OWLIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 01/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RETREAT AVE SUITE 811
HARTFORD CT
06106-2528
US

IV. Provider business mailing address

1 WHITFIELD HTS
AVON CT
06001-3955
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-5712
  • Fax: 860-520-4270
Mailing address:
  • Phone: 860-965-2055
  • Fax: 860-677-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number017276
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: