Provider Demographics
NPI:1346503612
Name:BEQIRI, EDMOND (MPA)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:
Last Name:BEQIRI
Suffix:
Gender:M
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2313
Mailing Address - Country:US
Mailing Address - Phone:203-734-7356
Mailing Address - Fax:860-571-3470
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 901
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-860-5450
Practice Address - Fax:860-545-5221
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2753363AM0700X
CT002753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002753OtherLICENSE