Provider Demographics
NPI:1376657080
Name:DAOUD, IBRAHIM M (MD)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:M
Last Name:DAOUD
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 1:95 WOODLAND ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1290
Mailing Address - Country:US
Mailing Address - Phone:860-714-6871
Mailing Address - Fax:860-714-6888
Practice Address - Street 1:95 WOODLAND ST FL 2
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-6871
Practice Address - Fax:860-714-6888
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017793208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010017793CT06OtherBCBS
CT010017793CT09OtherBCBS NEWINGTON
CT2334262OtherCIGNA
CT3962278OtherAETNA
CT001177930Medicaid
CT010017793CT08OtherBCBS WETHERSFIELD
CT202928529OtherUNITED HEALTHCARE
CT720239OtherCONNECTICARE
CT010017793CT07OtherBCBS ROCKYHILL
CTP471096OtherOXFORD HEALTH PLAN
CT010017793CT06OtherBCBS
CT3962278OtherAETNA
CT010017793CT08OtherBCBS WETHERSFIELD
CTB83874Medicare UPIN