Healthcare Provider Details

I. General information

NPI: 1376657080
Provider Name (Legal Business Name): IBRAHIM M DAOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WOODLAND ST FL 2
HARTFORD CT
06105
US

IV. Provider business mailing address

95 WOODLAND ST FL 2
HARTFORD CT
06105-1290
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-6871
  • Fax: 860-714-6888
Mailing address:
  • Phone: 860-714-6871
  • Fax: 860-714-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number017793
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: