Individual
MARYAM IFTIKHAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
672 SILAS DEANE HWY, WETHERSFIELD, CT 06109-3053
(860) 967-3600
Mailing address
38 BOLDUC CT, WOLCOTT, CT 06716-3146
(203) 578-5157
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4424
CT
Other
Enumeration date
04/10/2019
Last updated
04/10/2019
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