Doctor Name: | MALLICK QAISER ALAM |
NPI Number: | 1467529271 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 034112 |
Business Practice Address: | 77 Grand Ave New Haven, CT - 065133906 |
Business Phone Number: | 2035628697 |
Business Fax Number: | 2035621822 |
Mailing Address: | 77 Grand Ave, NEW HAVEN |
State: | CT |
Postal Code: | 065133906 |
Phone Number: | 2035628697 |
Fax Number: | 2035621822 |
NPI Enumeration Date: | 11/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 034112 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |