Basic Information
| Provider Information | |||||||||
| NPI: | 1346503612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEQIRI | ||||||||
| FirstName: | EDMOND | ||||||||
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| Credential: | MPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2110 SILAS DEANE HWY | ||||||||
| Address2: | |||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060672313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037347356 | ||||||||
| FaxNumber: | 8605713470 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 SEYMOUR ST | ||||||||
| Address2: | SUITE 901 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061065501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608605450 | ||||||||
| FaxNumber: | 8605455221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2012 | ||||||||
| LastUpdateDate: | 09/27/2018 | ||||||||
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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 | 363AM0700X | 2753 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 002753 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 002753 | 01 | CT | LICENSE | OTHER |