Provider Demographics
NPI:1972604528
Name:SHITIA, HUSAM BAHGAT (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSAM
Middle Name:BAHGAT
Last Name:SHITIA
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 1:430 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2562
Mailing Address - Country:US
Mailing Address - Phone:203-271-3132
Mailing Address - Fax:203-271-3940
Practice Address - Street 1:430 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2562
Practice Address - Country:US
Practice Address - Phone:203-271-3132
Practice Address - Fax:203-271-3940
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034996207RA0000X
FLME 72340207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT619002OtherAETNA
CT0V0544OtherHEALTHNET
CTG29889OtherUNITED HEALTH CARE
CT718079OtherCONNECTICARE
CT110134996CT01OtherRAIL ROAD MEDICARE
CT010034996CT01OtherANTHEM BLUE CROSS
CT010034996CT01OtherANTHEM BLUE CROSS
CTG29889OtherUNITED HEALTH CARE