Provider Demographics
NPI:1184666430
Name:HARBUT, ALICJA JADWIGA III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICJA
Middle Name:JADWIGA
Last Name:HARBUT
Suffix:III
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALICJA
Other - Middle Name:JADWIGA
Other - Last Name:HARBUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:25 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3509
Mailing Address - Country:US
Mailing Address - Phone:860-223-4146
Mailing Address - Fax:860-223-6908
Practice Address - Street 1:25 CLINTON ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3509
Practice Address - Country:US
Practice Address - Phone:860-223-4146
Practice Address - Fax:860-223-6908
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022670207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB84146Medicare UPIN