Individual
MALLICK QAISER ALAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
77 GRAND AVE, NEW HAVEN, CT 06513-3906
(203) 562-8697
(203) 562-1822
Mailing address
77 GRAND AVE, NEW HAVEN, CT 06513-3906
(203) 562-8697
(203) 562-1822
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
034112
CT
Other
Enumeration date
11/29/2006
Last updated
07/08/2007
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