Basic Information
| Provider Information | |||||||||
| NPI: | 1417900101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KASIR | ||||||||
| FirstName: | LAITH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 WILLARD AVE | ||||||||
| Address2: | |||||||||
| City: | NEWINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061112631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606666951 | ||||||||
| FaxNumber: | 8606676875 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060104923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603144400 | ||||||||
| FaxNumber: | 8603144407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 12/31/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 044097 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 044097 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 010044097CT02 | 01 | BCBS | OTHER | 49908884 | 01 | TRICARE | OTHER | 044097 | 01 | CONNECTICARE | OTHER | 1415607 | 01 | CIGNA | OTHER | 5743576 | 01 | AETNA | OTHER | 0014440974 | 05 | CT | MEDICAID |