Provider Demographics
NPI:1558488213
Name:ESLAMI-VARZANEH, FATIMA (MD)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:ESLAMI-VARZANEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SECRET HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1289
Mailing Address - Country:US
Mailing Address - Phone:203-452-9774
Mailing Address - Fax:
Practice Address - Street 1:200 WATSON BOULVARD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615
Practice Address - Country:US
Practice Address - Phone:203-380-4183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042185207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology