=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801094479
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAHBOOB AHMAD ASLAM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2007
-----------------------------------------------------
Last Update Date | 10/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 546 CROMWELL AVE SUITE 101
-----------------------------------------------------
City | ROCKY HILL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06067-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-757-3874
-----------------------------------------------------
Fax | 860-757-3875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 546 CROMWELL AVE SUITE 101
-----------------------------------------------------
City | ROCKY HILL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06067-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-969-1101
-----------------------------------------------------
Fax | 860-838-8170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084B0040X
-----------------------------------------------------
Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
-----------------------------------------------------
License Number | 047643
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 047643
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084A0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | 047643
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------