MEDICARE: DR. JAVED KHADER ELIYAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	325495	NY
2	207T00000X	Neurological Surgery Physician	MD2017-1071	NM
3	207T00000X	Neurological Surgery Physician	71453	CT

General Provider Information

NPI Number	:	1396991881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAVED KHADER ELIYAS MD

Provider Business Mailing Address
First Line	:	1000 ASYLUM AVE STE 3215
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1702
Country	:	US
Telephone Number	:	860-714-6980
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 ASYLUM AVE STE 3215
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1702
Country	:	US
Telephone Number	:	860-714-6980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2008
Last Update Date	:	10/09/2023

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