Provider Demographics
NPI:1629042973
Name:JHAWAR, SHIBA P (MD)
Entity Type:Individual
Prefix:MR
First Name:SHIBA
Middle Name:P
Last Name:JHAWAR
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 1:146 HAZARD AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-749-2258
Mailing Address - Fax:
Practice Address - Street 1:146 HAZARD AVE
Practice Address - Street 2:STE 107
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-749-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028112207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HAP310OtherOXFORD
OR3709OtherHEALTHNET
01228112OtherCIGNA
028112OtherCONNECTICARE
010028112CT01OtherBCBS
589331OtherAETNA
00128112000OtherBLUE CARE FAMILY
028112OtherCONNECTICARE
589331OtherAETNA