Healthcare Provider Details

I. General information

NPI: 1679893069
Provider Name (Legal Business Name): ASIMA KALEEM AHMAD MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST # T-209 YALE-NEW HAVEN HOSPITAL
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

20 YORK ST # T-209 YALE-NEW HAVEN HOSPITAL
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2259
  • Fax: 203-688-5599
Mailing address:
  • Phone: 203-688-2259
  • Fax: 203-688-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number0361446612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: