Provider Demographics
NPI:1508487190
Name:AFRIDI, ASMA
Entity Type:Individual
Prefix:
First Name:ASMA
Middle Name:
Last Name:AFRIDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WEST RD
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3730
Mailing Address - Country:US
Mailing Address - Phone:860-375-9122
Mailing Address - Fax:860-645-4151
Practice Address - Street 1:175 WEST RD
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-3730
Practice Address - Country:US
Practice Address - Phone:860-375-9122
Practice Address - Fax:860-645-4151
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT75691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program