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General NPI Number Information
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NPI Number | 1497327589
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Entity Type | Individual
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Provider Name | RAMI HASSAN HALLAK MD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 64 ROBBINS ST
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City | WATERBURY
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State | CT
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Zip | 06708-2613
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Country | US
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Telephone | 919-973-8483
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Fax |
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Provider Business Mailing Address
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Address Line | 64 ROBBINS ST
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City | WATERBURY
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State | CT
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Zip | 06708-2613
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Country | US
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Telephone | 919-973-8483
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 71550
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 59749
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License Number State | KY
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