Healthcare Provider Details

I. General information

NPI: 1093794521
Provider Name (Legal Business Name): AYSEGUL OZBEK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 S MAIN ST
MIDDLETOWN CT
06457-3649
US

IV. Provider business mailing address

90 S MAIN ST
MIDDLETOWN CT
06457-3649
US

V. Phone/Fax

Practice location:
  • Phone: 860-344-6300
  • Fax: 860-344-9249
Mailing address:
  • Phone: 860-344-6300
  • Fax: 860-344-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number040115
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number040115
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: