Provider Demographics
NPI:1467553248
Name:ASHRAF, MAHBOOB (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHBOOB
Middle Name:
Last Name:ASHRAF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MAHBOOB
Other - Middle Name:
Other - Last Name:ASHRAF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:41 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7413
Mailing Address - Country:US
Mailing Address - Phone:203-641-6836
Mailing Address - Fax:
Practice Address - Street 1:320 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1836
Practice Address - Country:US
Practice Address - Phone:860-928-6541
Practice Address - Fax:860-963-6450
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT044688OtherSTATE LICENSE