Healthcare Provider Details

I. General information

NPI: 1679910301
Provider Name (Legal Business Name): MARK K YOUSSEF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 05/24/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 MAIN ST S
SOUTHBURY CT
06488-4240
US

IV. Provider business mailing address

NAUGATUCK VALLEY RADIOLOGICAL ASSOCIATES 385 MAIN ST SOUTH
SOUTHBURY CT
06488
US

V. Phone/Fax

Practice location:
  • Phone: 203-267-5114
  • Fax:
Mailing address:
  • Phone: 203-267-5114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number72105
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number72105
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: