Basic Information
| Provider Information | |||||||||
| NPI: | 1588978795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALAZADEH | ||||||||
| FirstName: | SETAREH | ||||||||
| MiddleName: | LIBOT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 326 WASHINGTON ST | ||||||||
| Address2: | WILLIAM BACKUS HOSPITAL | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608898331 | ||||||||
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| Practice Location | |||||||||
| Address1: | 326 WASHINGTON ST | ||||||||
| Address2: | WILLIAM BACKUS HOSPITAL | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608898331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2010 | ||||||||
| LastUpdateDate: | 04/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 49459 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 49459 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.