Provider Demographics
NPI:1588197230
Name:MIAN, ISMA ARIF (MD)
Entity Type:Individual
Prefix:DR
First Name:ISMA
Middle Name:ARIF
Last Name:MIAN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:HHC CVO ENROLLMENT 1ST FLOOR
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-6970
Mailing Address - Fax:
Practice Address - Street 1:462 QUEEN STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1801
Practice Address - Country:US
Practice Address - Phone:860-621-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT066581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT066581OtherCT LIC