Healthcare Provider Details

I. General information

NPI: 1053757625
Provider Name (Legal Business Name): AMR AHMED ELMEKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 VAUXHALL STREET EXT STE 105
WATERFORD CT
06385-4331
US

IV. Provider business mailing address

320 POMFRET ST
PUTNAM CT
06260-1836
US

V. Phone/Fax

Practice location:
  • Phone: 860-816-2606
  • Fax:
Mailing address:
  • Phone: 860-928-6541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number62204
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD458591
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: