Provider Demographics
NPI:1467544239
Name:CONNECTICUT SURGEONS, LLC
Entity Type:Organization
Organization Name:CONNECTICUT SURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-714-6871
Mailing Address - Street 1:95 WOODLAND ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1230
Mailing Address - Country:US
Mailing Address - Phone:860-714-6871
Mailing Address - Fax:860-714-6888
Practice Address - Street 1:95 WOODLAND ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-7447
Practice Address - Fax:860-727-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1487663118OtherHONORE NPI
CT2V5964OtherHONORE HEALTHNET
CT1200451012OtherBARBA CIGNA
CT622478OtherBARBA CTCARE
CT010033106CT03OtherBARBA BCBS
CT004245602Medicaid
CT2V6493OtherBARBA HEALTHNET
CT3962260OtherBARBA AETNA
CT001331066Medicaid
CT400002988CT01OtherHONORE BCBS ANTHEM
CTP3887114OtherBARBA OXFORD
CT00133106602OtherBARBA BCFP
CT1679581359OtherBARBA NPI
CT622478OtherBARBA CTCARE
CT3962260OtherBARBA AETNA