Provider Demographics
NPI:1417900101
Name:KASIR, LAITH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAITH
Middle Name:
Last Name:KASIR
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 1:555 WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2631
Mailing Address - Country:US
Mailing Address - Phone:860-666-6951
Mailing Address - Fax:860-667-6875
Practice Address - Street 1:420 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4923
Practice Address - Country:US
Practice Address - Phone:860-314-4400
Practice Address - Fax:860-314-4407
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044097207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
010044097CT02OtherBCBS
49908884OtherTRICARE
044097OtherCONNECTICARE
1415607OtherCIGNA
5743576OtherAETNA
CT0014440974Medicaid
5743576OtherAETNA
CT110009891Medicare PIN