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General NPI Number Information
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NPI Number | 1487861712
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Entity Type | Individual
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Provider Name | WAEL ELMALLAH MD, MSC, PHD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 1 LAKE ST SUITE 204
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City | NEW BRITAIN
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State | CT
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Zip | 06052-1396
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Country | US
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Telephone | 860-223-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 SILAS DEANE HWY
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City | ROCKY HILL
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State | CT
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Zip | 06067-2353
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Country | US
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Telephone | 860-258-3480
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Fax | 860-571-6800
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35. 091561
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RA0002X
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Taxonomy Name | Adult Congenital Heart Disease Physician
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License Number | 55451
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 55451
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35. 091561
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 55451
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License Number State | CT
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