Provider Demographics
NPI:1144200122
Name:QURAISHI, SULTAN A (MD)
Entity Type:Individual
Prefix:
First Name:SULTAN
Middle Name:A
Last Name:QURAISHI
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 1:677 SILVER LN
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1257
Mailing Address - Country:US
Mailing Address - Phone:860-569-7399
Mailing Address - Fax:860-895-8107
Practice Address - Street 1:677 SILVER LN
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1257
Practice Address - Country:US
Practice Address - Phone:860-569-7399
Practice Address - Fax:860-895-8107
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030076208600000X, 208D00000X, 207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00199717003OtherCIGNA
CT4245029OtherAETNA
CT781160OtherCONNECTICARE
CT0199717OtherCIGNA
CT010030076CT01OtherANTHEM BCBS & BLUE CARE
CT0000089834615OtherUNITED HEALTHCARE
CT001300764Medicaid
CTHAS028OtherOXFORD
CT4245029OtherAETNA
CT0199717OtherCIGNA
CT010030076CT01OtherANTHEM BCBS & BLUE CARE