Healthcare Provider Details

I. General information

NPI: 1750401071
Provider Name (Legal Business Name): ALIREZA AFSHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CHURCH HILL RD
NEWTOWN CT
06470
US

IV. Provider business mailing address

33 CHURCH HILL RD
NEWTOWN CT
06470
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-5554
  • Fax: 203-426-7888
Mailing address:
  • Phone: 203-426-5554
  • Fax: 203-426-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number045227
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: