Provider Demographics
NPI:1366546756
Name:TARABAR, SANELA (MD)
Entity type:Individual
Prefix:
First Name:SANELA
Middle Name:
Last Name:TARABAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CHAPEL ST.
Mailing Address - Street 2:SASINT RAPHAEL FACULTY PHYSICIANS
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4405
Mailing Address - Country:US
Mailing Address - Phone:203-789-4044
Mailing Address - Fax:203-789-3007
Practice Address - Street 1:1450 CHAPEL ST.
Practice Address - Street 2:SASINT RAPHAEL FACULTY PHYSICIANS
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-4044
Practice Address - Fax:203-789-3007
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT041099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001410993Medicaid
CT001410993Medicaid
P00383938Medicare PIN
H94560Medicare UPIN
CT110010020Medicare PIN