Provider Demographics
NPI:1013018357
Name:RASOOL, ALTAF (MD)
Entity Type:Individual
Prefix:DR
First Name:ALTAF
Middle Name:
Last Name:RASOOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 NORWICH NEW LONDON TPKE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-2518
Mailing Address - Country:US
Mailing Address - Phone:860-367-0087
Mailing Address - Fax:
Practice Address - Street 1:88 NORWICH NEW LONDON TPKE
Practice Address - Street 2:SUITE 2
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2518
Practice Address - Country:US
Practice Address - Phone:860-367-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034177207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12373437OtherMULTIPLAN
CT5479643-1071553OtherAETNA
CT001341776Medicaid
CT034177OtherCONNECTICARE
CT010034177CT02OtherBC/BS
CT5479643-1057846OtherAETNA -INTERNAL MEDICINE
CT6848847OtherSIGNA
CTC01668OtherPTAN
CT2560336OtherUNITED HEALTH
CT2V7239OtherHEALTH NET
CTP3625618OtherOXFORD
CT2V7239OtherHEALTH NET
CT034177OtherCONNECTICARE