Provider Demographics
NPI:1174979512
Name:TARIQ, OOSMAN
Entity type:Individual
Prefix:
First Name:OOSMAN
Middle Name:
Last Name:TARIQ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2913
Mailing Address - Country:US
Mailing Address - Phone:860-747-6641
Mailing Address - Fax:860-747-2028
Practice Address - Street 1:184 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2913
Practice Address - Country:US
Practice Address - Phone:860-747-5766
Practice Address - Fax:860-747-2028
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT64911207R00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program