Provider Demographics
NPI:1871516054
Name:HAIDER, LALARUKH (MD)
Entity type:Individual
Prefix:
First Name:LALARUKH
Middle Name:
Last Name:HAIDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LALARUKH
Other - Middle Name:M
Other - Last Name:SHARIF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD MBBS
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2212
Mailing Address - Country:US
Mailing Address - Phone:860-679-7503
Mailing Address - Fax:860-679-1610
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:NEPHROLOGY
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-3835
Practice Address - Country:US
Practice Address - Phone:860-679-2160
Practice Address - Fax:860-679-1042
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042738207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1871516054Medicaid
CTD400038126Medicare PIN
I34438Medicare UPIN