Provider Demographics
NPI:1881851616
Name:PAZOOKI, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:PAZOOKI
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 1:100 HAYNES ST FL 2
Mailing Address - Street 2:DEQUATTRO CANCER CENTER
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4113
Mailing Address - Country:US
Mailing Address - Phone:860-646-0670
Mailing Address - Fax:860-643-9388
Practice Address - Street 1:43 WOODLAND ST
Practice Address - Street 2:SUITE G-80, GOTHIC PARK
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2362
Practice Address - Country:US
Practice Address - Phone:860-527-5803
Practice Address - Fax:860-525-3687
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047129207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400072460Medicare PIN