Provider Demographics
NPI:1467783290
Name:BALOUCH, IMRAN LASHARI (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:LASHARI
Last Name:BALOUCH
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 1:145 UNION ST
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3025
Mailing Address - Country:US
Mailing Address - Phone:860-896-0377
Mailing Address - Fax:860-896-0388
Practice Address - Street 1:145 UNION ST
Practice Address - Street 2:ECHN HEALTH SEVICES
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-3025
Practice Address - Country:US
Practice Address - Phone:860-896-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-132993207RG0100X
CT48248207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4996078OtherCIGNA
CT9808521OtherAETNA
CT9808521OtherAETNA