Healthcare Provider Details

I. General information

NPI: 1659637932
Provider Name (Legal Business Name): HIKMAT H SHAARBAF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 D NORTH TURNPIKE ROAD
WALLINGFORD CT
06492
US

IV. Provider business mailing address

100 D NORTH TURNPIKE ROAD
WALLINGFORD CT
06492
US

V. Phone/Fax

Practice location:
  • Phone: 203-309-0070
  • Fax: 203-309-0071
Mailing address:
  • Phone: 203-309-0070
  • Fax: 203-309-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number48245
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: