Basic Information
| Provider Information | |||||||||
| NPI: | 1982271250 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GHAZAL | ||||||||
| FirstName: | FATIMA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 263 FARMINGTON AVENUE. LM068 | ||||||||
| Address2: | UCONN HEALTH - GRADUATE MEDICAL EDUCATION | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060301921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606792147 | ||||||||
| FaxNumber: | 8606796424 | ||||||||
| Practice Location | |||||||||
| Address1: | 132 JEFFERSON STREET | ||||||||
| Address2: | HARTFORD HOSPITAL, ADULT PRIMARY CARE | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609720200 | ||||||||
| FaxNumber: | 8805453149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2021 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.