Healthcare Provider Details

I. General information

NPI: 1760647176
Provider Name (Legal Business Name): SAMEER SYED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE GAYLORD HOSPITAL 50 GAYLORD FARM ROAD
WALLINGFORD CT
06492
US

IV. Provider business mailing address

THE GAYLORD HOSPITAL 50 GAYLORD FARM ROAD
WALLINGFORD CT
06492
US

V. Phone/Fax

Practice location:
  • Phone: 203-679-3553
  • Fax: 203-284-2847
Mailing address:
  • Phone: 203-679-3553
  • Fax: 203-284-2847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number048491
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: