Provider Demographics
NPI:1134129646
Name:OWLIA, DARIUSH (MD)
Entity Type:Individual
Prefix:DR
First Name:DARIUSH
Middle Name:
Last Name:OWLIA
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 1:1 WHITFIELD HTS
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3955
Mailing Address - Country:US
Mailing Address - Phone:860-965-2055
Mailing Address - Fax:860-677-6850
Practice Address - Street 1:100 RETREAT AVE
Practice Address - Street 2:SUITE 811
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2528
Practice Address - Country:US
Practice Address - Phone:860-522-5712
Practice Address - Fax:860-520-4270
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017276207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOS2420OtherHEALTHNET INS. ID#
CT001172766Medicaid
CTP12038310OtherMULTIPLAN ID#
CT052169-0446OtherCONNECTICARE INS. ID #
CT781651OtherAETNA INS. ID #
CT0184408002OtherCIGNA HEALTHPLAN ID#
CT010017276CT01OtherANTHEM BC/BS ID#
CTP1302020OtherOXFORD HEALTHPLANS ID#
CTP12038310OtherMULTIPLAN ID#
CT001172766Medicaid