Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2009-01180 | NC |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 056905 | CT |
N | 208D00000X | General Practice Physician | 2009-01180 | NC |
NPI | 1215128202 |
---|---|
Provider Name | Wahila Alam |
First Address | Farmington, CT 06030-8082 |
Second Address | Farmington, CT 06030-8082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 20/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2075437 | (02) | NC |