Healthcare Provider Details

I. General information

NPI: 1013250836
Provider Name (Legal Business Name): ASMAA FERDJALLAH MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SARGENT DR
NEW HAVEN CT
06511-6100
US

IV. Provider business mailing address

150 SARGENT DR
NEW HAVEN CT
06511-6100
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-7411
  • Fax:
Mailing address:
  • Phone: 203-777-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number83625
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: