Provider Demographics
NPI:1881793511
Name:MEDICAL CARE CENTER OF CHESHIRE,INC
Entity type:Organization
Organization Name:MEDICAL CARE CENTER OF CHESHIRE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSAM
Authorized Official - Middle Name:BAHGAT
Authorized Official - Last Name:SHITIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-271-3132
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72340207RA0000X
CT034996207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT718079OtherCONNECTICARE
CTG29889OtherUNITED HEALTH CARE
CT619002OtherAETNA
CT0V0544OtherHEALTHNET
CT010034996CT01OtherBLUE CROSS
CT010034996CT01OtherBLUE CROSS
CT718079OtherCONNECTICARE
CTG29889Medicare UPIN
CTC00437Medicare ID - Type Unspecified