Provider Demographics
NPI:1447384326
Name:GHUMMAN, KHURAM R (MD, MPH, CPE, FAAFP)
Entity Type:Individual
Prefix:
First Name:KHURAM
Middle Name:R
Last Name:GHUMMAN
Suffix:
Gender:M
Credentials:MD, MPH, CPE, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CHURCH ST
Mailing Address - Street 2:PO BOX 518
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9406
Mailing Address - Country:US
Mailing Address - Phone:860-653-4526
Mailing Address - Fax:860-653-5209
Practice Address - Street 1:13 CHURCH ST
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9406
Practice Address - Country:US
Practice Address - Phone:860-653-4526
Practice Address - Fax:860-653-5209
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447384326OtherNPI