Provider Demographics
NPI:1346361714
Name:USMAN, MANZOOR MUSTAFA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANZOOR
Middle Name:MUSTAFA
Last Name:USMAN
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 1:77 JUDY LN
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-2102
Mailing Address - Country:US
Mailing Address - Phone:203-249-6355
Mailing Address - Fax:
Practice Address - Street 1:29 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1312
Practice Address - Country:US
Practice Address - Phone:860-826-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0483142084P0804X
VA01012462432084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry