Provider Demographics
NPI:1376579946
Name:KIDWAI, WAJIH ZAHEER (MD)
Entity Type:Individual
Prefix:
First Name:WAJIH
Middle Name:ZAHEER
Last Name:KIDWAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WAJIH
Other - Middle Name:
Other - Last Name:ZAHEER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:300 GEORGE ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6624
Mailing Address - Country:US
Mailing Address - Phone:203-785-6610
Mailing Address - Fax:203-785-6414
Practice Address - Street 1:111 GOOSE LANE
Practice Address - Street 2:SUITE 1300
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437
Practice Address - Country:US
Practice Address - Phone:203-453-9192
Practice Address - Fax:203-453-0875
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031863207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001318634Medicaid
CTD400059249Medicare PIN
G05282Medicare UPIN