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General NPI Number Information
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NPI Number | 1346361714
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Entity Type | Individual
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Provider Name | MANZOOR MUSTAFA USMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 29 RUSSELL ST
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City | NEW BRITAIN
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State | CT
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Zip | 06052-1312
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Country | US
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Telephone | 860-826-4985
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Fax |
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Provider Business Mailing Address
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Address Line | 77 JUDY LN
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City | STAMFORD
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State | CT
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Zip | 06906-2102
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Country | US
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Telephone | 203-249-6355
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 048314
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 0101246243
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License Number State | VA
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