Healthcare Provider Details

I. General information

NPI: 1033183355
Provider Name (Legal Business Name): LYDIA AOUN-BARAKAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GRANDVIEW AVE SUITE #L01
WATERBURY CT
06708-2505
US

IV. Provider business mailing address

1625 STRAITS TPKE SUITE #201
MIDDLEBURY CT
06762-1805
US

V. Phone/Fax

Practice location:
  • Phone: 203-574-4187
  • Fax: 203-591-1453
Mailing address:
  • Phone: 203-573-9512
  • Fax: 203-568-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number037009
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: