Healthcare Provider Details

I. General information

NPI: 1447353537
Provider Name (Legal Business Name): MINA RASOULPOUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ELLSWORTH RD
WEST HARTFORD CT
06107-2313
US

IV. Provider business mailing address

8 ELLSWORTH RD
WEST HARTFORD CT
06107-2313
US

V. Phone/Fax

Practice location:
  • Phone: 860-233-8523
  • Fax: 860-233-1673
Mailing address:
  • Phone: 860-233-8523
  • Fax: 860-233-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number022619
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: