Healthcare Provider Details

I. General information

NPI: 1255986121
Provider Name (Legal Business Name): KHALED ABAZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SAYBROOK RD STE A
MIDDLETOWN CT
06457-4859
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-636-2010
  • Fax: 860-636-2045
Mailing address:
  • Phone: 860-972-5507
  • Fax: 860-972-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number84918
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: