Healthcare Provider Details

I. General information

NPI: 1295021962
Provider Name (Legal Business Name): AMNA IQBAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 TOWN BROOKE
MIDDLETOWN CT
06457-6621
US

IV. Provider business mailing address

8211 TOWN BROOKE
MIDDLETOWN CT
06457-6621
US

V. Phone/Fax

Practice location:
  • Phone: 708-257-5740
  • Fax:
Mailing address:
  • Phone: 708-257-5740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1295021962
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number53576
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: