Healthcare Provider Details

I. General information

NPI: 1790766368
Provider Name (Legal Business Name): ASIM F TARABAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVENUE VA CONNECTICUT HEALTHCARE SYSTEM
WEST HAVEN CT
06516
US

IV. Provider business mailing address

20 YORK ST YALE NEW HAVEN HOSPITAL
NEW HAVEN CT
06510
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax: 203-937-3474
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number038652
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberCT038652
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: