Provider Demographics
NPI:1780839977
Name:A.AZIZ RICHI, MD, LLC
Entity Type:Organization
Organization Name:A.AZIZ RICHI, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:A.AZIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-753-0877
Mailing Address - Street 1:1389 W MAIN ST
Mailing Address - Street 2:SUITE 322
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3104
Mailing Address - Country:US
Mailing Address - Phone:203-753-0877
Mailing Address - Fax:203-759-1537
Practice Address - Street 1:1389 W MAIN ST
Practice Address - Street 2:SUITE 322
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3104
Practice Address - Country:US
Practice Address - Phone:203-753-0877
Practice Address - Fax:203-759-1537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001200674Medicaid
CT001200674Medicaid