Basic Information
Provider Information | |||||||||
NPI: | 1467553248 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ASHRAF | ||||||||
FirstName: | MAHBOOB | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ASHRAF | ||||||||
OtherFirstName: | MAHBOOB | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 41 SENECA DR | ||||||||
Address2: |   | ||||||||
City: | MERIDEN | ||||||||
State: | CT | ||||||||
PostalCode: | 064507413 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2036416836 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 320 POMFRET ST | ||||||||
Address2: |   | ||||||||
City: | PUTNAM | ||||||||
State: | CT | ||||||||
PostalCode: | 062601836 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8609286541 | ||||||||
FaxNumber: | 8609636450 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/26/2006 | ||||||||
LastUpdateDate: | 05/02/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 044688 | CT | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 044688 | 01 | CT | STATE LICENSE | OTHER |