Provider Demographics
NPI:1942408265
Name:QURESHI, OSMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:OSMAN
Middle Name:
Last Name:QURESHI
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 1:71 HAYNES ST
Mailing Address - Street 2:MANCHESTER MEMORIAL HOSPITAL
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4131
Mailing Address - Country:US
Mailing Address - Phone:860-647-6827
Mailing Address - Fax:860-533-3452
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:MANCHESTER MEMORIAL HOSPITAL
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-647-6827
Practice Address - Fax:860-533-3452
Is Sole Proprietor?:No
Enumeration Date:2007-07-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0469352084P0800X
CT77792084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004025177Medicaid
CT004025177Medicaid
CTD400000855 - C00814Medicare PIN
CTD400033536Medicare PIN
CTD400085934Medicare PIN