Provider Demographics
NPI:1407961741
Name:QI, JIAFAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JIAFAN
Middle Name:
Last Name:QI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-3985
Mailing Address - Country:US
Mailing Address - Phone:860-679-2980
Mailing Address - Fax:860-679-4334
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-3985
Practice Address - Country:US
Practice Address - Phone:860-679-2980
Practice Address - Fax:860-679-4334
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12032207ZP0102X
CT041515207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7058397Medicaid
RIH92329Medicare UPIN