Basic Information
| Provider Information | |||||||||
| NPI: | 1134129646 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWLIA | ||||||||
| FirstName: | DARIUSH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 WHITFIELD HTS | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060013955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609652055 | ||||||||
| FaxNumber: | 8606776850 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 RETREAT AVE | ||||||||
| Address2: | SUITE 811 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061062528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605225712 | ||||||||
| FaxNumber: | 8605204270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 01/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 017276 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | OS2420 | 01 | CT | HEALTHNET INS. ID# | OTHER | 001172766 | 05 | CT | MEDICAID | P12038310 | 01 | CT | MULTIPLAN ID# | OTHER | 052169-0446 | 01 | CT | CONNECTICARE INS. ID # | OTHER | 781651 | 01 | CT | AETNA INS. ID # | OTHER | 0184408002 | 01 | CT | CIGNA HEALTHPLAN ID# | OTHER | 010017276CT01 | 01 | CT | ANTHEM BC/BS ID# | OTHER | P1302020 | 01 | CT | OXFORD HEALTHPLANS ID# | OTHER |