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General NPI Number Information
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NPI Number | 1508599275
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Entity Type | Individual
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Provider Name | OMAR AKHTAR
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Gender | Male
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 179 TALCOTTVILLE RD
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City | VERNON
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State | CT
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Zip | 06066-4615
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Country | US
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Telephone | 860-986-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 723 NEVERS RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-1404
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Country | US
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Telephone | 860-690-1062
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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