Provider Demographics
NPI:1285689901
Name:OLOUFA, ASHRAF M (MD)
Entity Type:Individual
Prefix:
First Name:ASHRAF
Middle Name:M
Last Name:OLOUFA
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-5500
Mailing Address - Fax:352-265-5504
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1253
Practice Address - Country:US
Practice Address - Phone:203-709-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067006L2084P0800X
FLME1049192084P0800X
CT634472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50050052OtherCAPITAL BLUE CROSS
PA0017947990016Medicaid
PA000928243OtherHIGHMARK BLUE SHIELD
FLDD310YMedicare PIN
PA0017947990016Medicaid
PAG98087Medicare UPIN