Provider Demographics
NPI:1427076330
Name:GAZI, GOLAM ROSUL (MD)
Entity type:Individual
Prefix:DR
First Name:GOLAM
Middle Name:ROSUL
Last Name:GAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1700
Mailing Address - Country:US
Mailing Address - Phone:860-529-8670
Mailing Address - Fax:860-529-8790
Practice Address - Street 1:350 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1700
Practice Address - Country:US
Practice Address - Phone:860-529-8670
Practice Address - Fax:860-529-8790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17479207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOV7812OtherHEALTHNET
CT001174796OtherUNITED HEALTHCARE
CT054027OtherCONNECTICARE
CT010017479CT01OtherBLUE CROSS BLUE SHIELD
CT001174796Medicaid
CT4227408OtherAETNA
CTP1933998OtherOXFORD
CT2379856OtherAETNA US HEALTHCARE
CT001174796OtherUNITED HEALTHCARE
CT100000050Medicare PIN