Provider Demographics
NPI:1063141729
Name:SALEH, ZIDAN MOHAMMAD ZIDAN
Entity type:Individual
Prefix:
First Name:ZIDAN
Middle Name:MOHAMMAD ZIDAN
Last Name:SALEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ADULT PRIMARY CARE AT HARTFORD HOSPITAL
Mailing Address - Street 2:132 JEFFERSON STREET
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-972-0200
Mailing Address - Fax:860-545-3149
Practice Address - Street 1:132 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-972-0200
Practice Address - Fax:860-545-3149
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program