Healthcare Provider Details

I. General information

NPI: 1699115691
Provider Name (Legal Business Name): ABDUL HASEEB QAZI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/31/2021
Certification Date: 07/31/2021
Deactivation Date: 04/03/2014
Reactivation Date: 05/14/2014

III. Provider practice location address

114 WOODLAND ST
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

114 WOODLAND ST
HARTFORD CT
06105-1208
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-9944
  • Fax:
Mailing address:
  • Phone: 860-714-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number1.068984
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: